Cinemeducation

Movies have long been utilized to highlight varied areas in the field of psychiatry, including the role of the psychiatrist, issues in medical ethics, and the stigma toward people with mental illness. Furthermore, courses designed to teach psychopathology to trainees have traditionally used examples from art and literature to emphasize major teaching points. The integration of creative methods to teach psychiatry residents is essential as course directors are met with the challenge of captivating trainees with increasing demands on time and resources. Teachers must continue to strive to create learning environments that give residents opportunities to apply, analyze, synthesize, and evaluate information (1). To reach this goal, the use of film for teaching may have advantages over traditional didactics. Films are efficient, as they present a controlled patient scenario that can be used repeatedly from year to year. Psychiatry residency curricula that have incorporated viewing contemporary films were found to be useful and enjoyable pertaining to the field of psychiatry in general (2) as well as specific issues within psychiatry, such as acculturation (3). The construction of a formal movie club has also been shown to be a novel way to teach psychiatry residents various aspects of psychiatry (4).

Introducing REDRUMTM

Building on Kalra et al. (4), we created REDRUMTM (Reviewing [Mental] Disorders with a Reverent Understanding of the Macabre), a Psychopathology curriculum for PGY-1 and -2 residents at Rutgers Robert Wood Johnson Medical School. REDRUMTM teaches topics in mental illnesses by use of the horror genre. We chose this genre in part because of its immense popularity; the tropes that are portrayed resonate with people at an unconscious level. Despite selected works being primarily “monster movies,” great care is taken not to perpetuate the stigma of mental illness or to portray patients as “monsters.”

The main objective of the REDRUMTM Psychopathology course is to enhance learning through creative discussion of examples of psychopathology that come from film and literature which is augmented by reading selected chapters from the required textbook, Kaplan & Sadock’s Synopsis of Psychiatry (5). This is achieved by selected works serving a metaphorical or symbolic role in the etiology, clinical presentation, course, and prognosis of the mental illnesses highlighted in our course syllabus. Our selected movie list that comprises the course syllabus has itself evolved into its own didactic titled “52in52.”

Origin of 52in52

When Bruce Campbell retweeted the United States of Horror Movies map (pic.twitter.com/JTmemXHfOf), little did he know that he would help create our Psychopathology course syllabus. All of the movies that participating students and residents watch to prepare for REDRUMTM are included on the map. Since participants watch an average of one movie per week, we titled our course syllabus “52in52.” The syllabus becomes its own didactic

With the commencement of the 2014-15 academic year, the course directors at Rutgers Robert Wood Johnson Medical School decided to frame the movie schedule as a virtual road trip across the United States, using GroovyBruce’s map as a guide. Beginning the week of July 1, 2014, we “visited” one state each week as listed in our itinerary by watching the movie assigned to that state. In addition to the movie supplementing the weekly PowerPoint lecture, the discussion during the session resulted in a weekly blog on how the movie related to pertinent teaching points in psychiatry and psychopathology. This website houses a compilation of our 52in52 blogs.

References

1. Lynd-Balta E: Using literature and innovative assessments to ignite interest and cultivate critical thinking skills in an undergraduate neuroscience course. CBE Life Sci Educ 2006; 5:167–174 2. Fritz GK, Poe RO: The role of a cinema seminar in psychiatric education. Am J Psychiatry 1979; 136:207–210 3. Sierles FS: Using film as the basis of an American Culture course for first-year psychiatry residents. Acad Psychiatry 2005; 29:100–104 4. Kalra G: Psychiatry Movie Club: a novel way to teach psychiatry. Indian J Psychiatry 2011; 53:258–260 5. Sadock BJ, Sadock VA: Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th Edition. Philadelphia, PA, Lippincott, Williams & Wilkins, 2007

Table of Contents Week Month State Movie Week Month State Movie July January

1 4 Maine Carrie 27 2 Tennessee Evil Dead

2 11 New Hampshire YBR 28 9 Kentucky Return Living Dead

3 18 Vermont Wolf 29 16 Indiana An American Crime

4 25 Massachusetts Jaws 30 23 Ohio Nightmare on Elm Street

August 31 30 West Virginia Wrong Turn

5 1 Rhode Island The Conjuring February

6 8 Connecticut I Spit on your Grave 32 6 Pennsylvania Night of the Living Dead

7 15 New York Amityville Horror 33 13 NJ Friday the 13th

8 22 Michigan Jingles 34 20 Delaware I Can See You

9 29 Wisconsin Giant Spider Invasion 35 27 Maryland The Blair Witch Project September March

10 5 Minnesota Jennifer's Body 36 6 Wash DC The Exorcist

11 12 North Dakota Leprechaun 37 13 Virginia Mama

12 19 Montana Alien Abduction 38 20 North Carolina Pumpkinhead

13 26 Idaho Idaho Transfer 39 27 South Carolina The New Daughter October April

14 3 Utah Carnival of Souls 40 3 Georgia Deliverance

15 10 Wyoming Close Encounters 41 10 Florida Jeepers Creepers

16 17 South Dakota Badlands 42 17 Alabama Laid to Rest

17 24 Iowa The Crazies 43 24 Mississippi The Beast Within

18 31 Illinois Halloween May

November 44 1 Louisiana Skeleton Key

19 7 Missouri You're Next 45 8 Texas Texas Chainsaw Massacre

20 14 Kansas Near Dark 46 15 Hawaii A Perfect Getaway

21 21 Nebraska Children of the Corn 47 22 Alaska 30 Days of Night

22 28 Colorado The Shining 48 29 Canada Cube December June

23 5 Arizona Psycho 49 5 Washington The Ring

24 12 New Mexico The Hills Have Eyes 50 12 Oregon The Fog

25 19 Oklahoma Terror at Tenkiller 51 19 Nevada Tremors

26 26 Arkansas Town Dreaded Sundown 52 26 California Scream

Movie of the week: Carrie (1976; 2013)

Synopsis

The original 1976 film is about a misfit high school girl, Carrie White, who discovers that she has telekinetic powers. Repressed by a domineering mother and bullied by her peers at school, her efforts to fit in lead to a dramatic confrontation during the senior prom. Following a mass murder in the high school gymnasium, Carrie breaks down in her mother's arms at home. Believing the devil has possessed her daughter, her mother tries to kill her. Carrie is cornered in the kitchen, but sends knives flying at her mother, pinning her to the wall and killing her.

How it relates to the field of psychiatry

The Feeding and Eating Disorder section of the DSM-5 includes feeding and eating disorders of infancy or early childhood as well as 3 specific diagnoses including Anorexia Nervosa and Bulimia Nervosa. Extensive research followed the dissemination of preliminary criteria for Binge Eating Disorder in Appendix B of DSM-IV, and findings supported the clinical utility and validity of its inclusion in the DSM-5.

Films that depict possession serve as a metaphor for dissociation. Accordingly, these films may be viewed as illustrations of mental disorders including dissociative and related disorders such as the feeding and eating disorders. Anorexia Nervosa may be conceptualized in psychodynamic terms as a reaction to the demand that adolescents behave more independently and increase their sexual functioning. Patients then replace preoccupations about eating for other age-specific pursuits.

A character analysis of Carrie reveals an adolescent who is unable to separate psychologically from her mother. Her body is perceived as though it is possessed by an introject of an intrusive, domineering and unempathic mother. Starvation serves as an unconscious means of starving and destroying the internalized mother-object. The tension between Carrie and her mother is evident throughout the movie and begins to crescendo before the senior prom. As Carrie gets ready for the evening, her mother tells her that everyone will laugh at her. Carrie defies her mother, leaving with her boyfriend, Tommy. In the movie’s penultimate scene, Carrie kills her mother in the kitchen by impaling her with knives, an act symbolic of her unconscious wish to destroy her intrusive mother. The setting (kitchen) and means (cutlery) are metaphorical for Anorexia Nervosa.

Key Words: Carrie, Stephen King, dissociation, dissociative disorders, feeding and eating disorders, Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, internalized mother- object

Next week’s movie: YellowBrickRoad (2010) Movie of the week: YellowBrickRoad (2010)

Last week’s movie: Carrie (1976; 2013)

Synopsis

One morning in 1940, the entire population of Friar, New Hampshire disappeared. 572 people left behind all of their possessions and walked together up a winding mountain trail into the wilderness never to be heard from again. A search party dispatched by the U.S. Army eventually discovered the remains of nearly 300 of Friar's evacuees. Many had frozen to death while others were slaughtered. Over the years, a quiet cover-up operation managed to weave the story of Friar into the stuff urban legends are made of. The town has slowly repopulated, but the vast wilderness is mostly untracked, with the northern-most stretches off limits to local hunters and loggers. In 2008, the coordinates for the "YELLOWBRICKROAD" trail head were declassified.

The first official expedition into the sick and twisted wilderness will attempt to solve the mystery of the lost citizens of Friar. The researchers’ hopes to turn a legend into an item of recorded history are jeopardized when their equipment fails; leaving them lost and at the will of what evil lurks in the woods.

How it relates to the field of psychiatry

In our curriculum at Rutgers-RWJMS, we relate episodic illnesses (such as Delirium and Major Depressive Disorder) to ghost stories. In their quest for discovery, the ghosts from 1940 Friar will haunt a group of researchers, allowing for YellowBrickRoad to be discussed in the context of Delirium. Serial mental status examinations by Walter (a psychologist) reveal progressive cognitive decline in the group that is abrupt in onset. One researcher, Daryl, demonstrates alterations in cognition and consciousness incident to his discovery of a hat that bears a resemblance to that of Elphaba’s, but is more appropriately comparable to the (Mad) Hatter’s in Lewis Carroll's novel Alice's Adventures in Wonderland. The Hatter is a principal character who is portrayed as “mad,” asking unanswerable riddles and reciting nonsensical poetry. His reality parallels that of the expedition in that he is trapped in a never-ending tea party; time having stopped, keeping him and the March Hare at 6:00 pm forever. While the Hatter is portrayed as mad, the phrase “Mad Hatter” doesn’t appear in Carroll’s works. Instead, it refers to a delirium caused by mercury poisoning that can be traced back to the 19th century when mercury-based compounds were used to make fine hats.

Daryl’s delirium however is not caused by mercury poisoning but is likely due to anticholinergic toxicity from deadly nightshade. Atropa belladonna (deadly nightshade) is an anticholinergic alkaloid amine (plant metabolite), and is one of the 3 subgroups of alkaloid amines which also include the hallucinogenic alkaloid amines and the stimulant alkaloid amines. The film may therefore be conceptualized as a depiction of delirium due to the direct physiologic effects of Atropa belladonna, i.e. anticholinergic toxicity.

In addition to serving as a case study of delirium “spread” through mechanisms of Shared Psychotic Disorder (versus mass poisoning), YellowBrickRoad also references Jungian theory by teaching the archetypal warning of “losing oneself in the wilderness.” This may be taken both metaphorically, as the characters stray from their own rationality, as well as literally. The original townspeople’s abandonment of Friar has less to do with what they were walking towards and more to do with what they were leaving behind and has its roots in manifest destiny. Accordingly, YellowBrickRoad should be viewed along with other rural gothic narratives such as The Shining (1980) and its own reference, the ill-fated Donner Party (1846–1847).

Key Words: YellowBrickRoad, Delirium, Elphaba, Wicked Witch of the West, Mad Hatter, Lewis Carroll, Alice's Adventures in Wonderland , March Hare, mercury poisoning, anticholinergic toxicity, deadly nightshade, Atropa belladonna, Shared Psychotic Disorder, Carl Gustav Jung, The Shining, Donner Party

Next week’s movie: Wolf (1994)

Movie of the week: Wolf (1994)

Last week’s movie: YellowBrickRoad (2010)

Synopsis

Wolf (1994) is a film adaptation of Otia imperialia, a form of speculum literature written by Gervase of Tilbury in the 13th century. In his book, Gervase describes a folkloric human with the ability to shapeshift into a wolf upon the appearance of the full moon.

The word “werewolf” is derived from Old English wer, which translates as “man.” The man- wolf is perhaps best portrayed in the 1941 film The Wolfman starring Lon Chaney Jr. In the 1994 re-make, Will Randall is bitten by a wolf while driving through Vermont after it was seemingly hit by his car. The accident is the beginning of a series of “cursed” events for the editor-in-chief; being stabbed in the heart back by his ambitious protégé, Stewart Swinton; learning that his wife is having an affair; and meeting the enigmatic Laura Alden, daughter of the ruthless tycoon behind the takeover of Will’s publishing house. The psychological toll of Will’s current events is paralleled by physiological changes ranging from increased libido to onset of primal sensory perceptions.

How it relates to the field of psychiatry

The essential feature of the Disruptive, Impulse-Control, and Conduct Disorders is the problem of self-control of emotions and behaviors that violate the rights of others. The curse of the werewolf symbolizes the affliction of Intermittent Explosive Disorder (IED). The common attribute of “turning into an animal” is metaphoric of IED. However, for IED to be diagnosed, the recurrent aggressive outbursts cannot be better explained by another mental disorder, the physiologic effects of a substance or another medical condition. The idea that a brain tumor may be causing Will’s symptoms is suggested by Laura, “I say we get you examined for physical causes before we take for granted that you're becoming [mentally ill].”

The shaman's rules discussed in Wolf represent a psychological formulation of IED. It is said that like our base, biological drives, “the wolf” is always present. It grows inside a man until the first full moon…and then it consumes him, killing all but his nature and his heart. This description parallels the development of the Freudian id. The analogue of the wolf is the superego, a culture’s prohibitions governed by the reality principle. The superego is externally represented by Will’s amulet that “holds the wolf at bay.”

The original term lycanthropy was applied to a supernatural condition in which men assumed the physical form of werewolves. This term has evolved into the classification “clinical lycanthropy” which is a syndrome whereby the individual demonstrates the delusion that he/she can transform into a wolf (or other animal). The various descriptions of lycanthropy across cultures serve to reinforce salient teaching points pertaining to the Disruptive, Impulse-Control, and Conduct Disorders. For example, in Russian folklore, a werewolf can be recognized by bristles under the tongue, which symbolizes the vulgar and abusive speech individuals with IED may describe as being beyond their control. Two additional examples follow.

Pyromania. In the Serbian culture, werewolves traditionally congregated annually in the winter months. The festival includes stripping off their wolf skins and hanging them from trees. They would then burn the skins, releasing the werewolf from its curse.

Kleptomania. In Haitian folklore, werewolves would typically try to steal children by waking mothers during the night and asking their permission to take their child.

Key Words: Otia imperialia, Gervase of Tilbury, werewolf, The Wolfman, Lon Chaney Jr., Disruptive, Impulse-Control and Conduct Disorders, Intermittent Explosive Disorder, Freud, id, superego, reality principle, lycanthropy, Pyromania, Kleptomania

Next week’s movie: Jaws (1975)

Movie of the week: Jaws (1975)

Last week’s movie: Wolf (1994)

Synopsis

Just when you thought it was safe to go back in the water, Peter Benchley’s “remake of Moby- Dick” was adapted to the screen. Inspired by the 1916 shark attacks down the Jersey shore, Jaws is the tale of a rogue shark that terrorizes the small island community of Amity. Jaws caused many viewers to be afraid to enter the ocean in the lost summer of ‘75, and established the notion of the great white as nature’s number one killing machine.

How it relates to the field of psychiatry

First described by Walter Bradford Cannon, the hypothalamus influences various emotional responses including the fight-or-flight response. Building on Cannon’s work, Jeffrey Alan Gray (1987) described a sequence of four defensive responses that occur depending on the organism’s proximity of danger; a) alert or vigilant immobility, b) escape, c) fighting and c) tonic immobility. While first three have been extensively studied in humans, tonic immobility has been primarily investigated in animal models.

Once thought to be nature’s apex predator, the numbers of great white sharks have diminished in recent years. There have been increasing reports of pods of killer whales hunting great whites utilizing tonic immobility by turning the shark on its dorsum. The shark then enters a natural state of paralysis and may remain in this state for up to 15 minutes. Tonic immobility is a limbic system function that therefore serves as an animal model for dissociative-like symptoms experienced in the anxiety, trauma- and stressor-related disorders including Post-Traumatic Stress Disorder.

Much like a zombie apocalypse serving as a backdrop to the Romerian group dynamic, the rogue great white shark attacks are the setting for the film’s main characters to interact. Brody has a past psychiatric history significant for specific phobia, natural environment type (irrational fear of the water), and acts to mediate the conflict between Hooper and Quint, both of whom have histories of prior trauma. Hooper has an experience with a thresher shark that “ate his boat” when he was a young boy. Quint also shared his encounter with a thresher’s tail when he shows Hooper a scar on his right leg. Right after, Brody points out a tattoo on Quint’s left arm of the USS Indianapolis, marking Quint as a survivor of the greatest single loss of life at sea in US Naval history. Quint relates the story of the ship that was torpedoed by a Japanese submarine. Of the 900-11,000 men who entered the water, only 317 survived; largely the result of the largest shark frenzy in recorded history (probably the oceanic white tip).

Despite having past traumatic experiences, both Hooper and Quint chose careers at sea. This likely represents their employing denial, and developing a counterphobic attitude (Otto Fenichel) that results in them running towards (instead of avoidance/away from) their fear. The final line of the movie, “I used to hate the water…I can’t imagine why,” illustrates the effect of flooding in extinguishing the learned (avoidant) behavior. Of course – and ironically – Brody’s “therapy” takes places while the Orca is flooded after being rammed by the great fish; a reincarnation of the rogue sperm whale that sank the Essex in 1820 (inspiration for Moby-Dick).

Key Words: Peter Benchley, Moby-Dick, Jersey shore, Jaws, Walter Bradford Cannon, hypothalamus, fight-or-flight, Jeffrey Alan Gray, tonic immobility, limbic system, anxiety disorders, trauma- and stressor-related disorders, Post-Traumatic Stress Disorder, specific phobia, USS Indianapolis, oceanic white tip, counterphobic attitude, Otto Fenichel, flooding, Essex

Psycho-nicity: ‘Synchronicity’ is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. One should take every opportunity to watch Jaws as part of a ‘movies on the beach’ event.

Next week’s movie: The Conjuring (2013)

Movie of the week: The Conjuring (2013)

Last week’s movie: Jaws (1975)

Synopsis

In 1970, Carolyn Perron purchased a Raggedy Ann doll for her daughter, Donna. Following a series of unexplained phenomena, the Perron family contacted an Episcopalian priest, who in turn consulted the world’s most renowned paranormal investigators (opening credits) Ed and Lorraine Warren. The Warrens identified the doll as a conduit for a demon. The Conjuring is based on the true story of the Perron family, set in their 18th-century Rhode Island farmhouse built on a plot of land cursed by Bathsheba Sherman (whose sister was hanged in the Salem witch trials). The film depicts the Perron family’s battle with the demon over the soul of their youngest daughter, Donna.

How it relates to the field of psychiatry

At Rutgers Robert Wood Johnson Medical School, the first module – titled Necromancy – of our year-long resident Psychopathology course incorporates ghosts (wraiths) and demons. While the former references disorders that are episodic in nature, tales of demonic possession serve to reinforce teaching points of chronic and persistent illnesses such as the Dissociative Disorders (DD). At the completion of the DD block, participants should appreciate that movies about demonic possession may be metaphorically interpreted as case studies of dissociation. Specifically, the hallmark characteristic of Dissociative Identity Disorder, a disruption of identity, may be described in some cultures as an experience of possession (DSM-5).

The seminal movie of the subgenre is William Friedkin’s 1973 film adaptation of The Exorcist (but we’ll have to wait until Week 36 for that!). The Conjuring is homage to Friedkin’s film, thus reinforcing several teaching points germane to DID.

The experiences of the Perron children include imaginary friends and archetypal fears of sleeping above the covers (but not “four feet above her covers” - Ghostbusters, 1984). Cindy has an imaginary friend, Rory, who is seen “in the mirror behind you” when the music from the music box stops. Such childhood fantasy may be a defense against family dissonance which is intimated by Cindy demonstrating evidence of parasomnias such as sleepwalking and sleep- related rhythmic movement disorder (nocturnal head banging). While nocturnal head banging can occur during any stage of sleep, sleepwalking is differentiated from REM sleep behavior disorder in that it only occurs during non-rapid eye movement (NREM) sleep.

The movie ends with Lorraine Warren’s comment, “There's a case in Long Island he'd like to discuss…” We too will visit the Amityville Horror house, but not before a brief stop in Connecticut (next week’s movie!). Key Words: The Conjuring, Carolyn Perron, Raggedy Ann, Lorraine Warren, Bathsheba Sherman, Dissociative Disorders, Dissociative Identity Disorder, William Friedkin, The Exorcist, imaginary friend, fantasy, parasomnia, sleep medicine, sleepwalking, sleep-related rhythmic movement disorder, REM sleep behavior disorder

Next week’s movie: I Spit on Your Grave (1978)

Movie of the week: I Spit on Your Grave (1978)

Last week’s movie: The Conjuring (2013)

Synopsis

Jennifer Hill sets out to write her novel at a summer cottage she rented in Connecticut, about three hours north of NYC. This is the second time in three weeks we’ve followed a New Yorker to New England to pursue their vocational goals. In Jaws, we discovered that Sheriff Brody was presumably traumatized when he was younger (and fears the ocean). In this 1978 cult classic revenge film, Jenny is the victim of a gang rape within the first 30 minutes of the movie. Her last stop before reaching her summer retreat is a rustic gas station a la Joss Whedon’s Cabin in the Woods. Instead of meeting ‘the harbinger,’ the attendant welcomes her, saying she’ll love the area. His words introduce a plot that Time Magazine ranked among the Top 10 Ridiculously Violent Movies of all time.

How it relates to the field of psychiatry

Nearly one-third of all rape victims develop Posttraumatic Stress Disorder (PTSD) sometime during their lifetime, and more than 11% go on to have chronic symptoms (National Center for Victims of Crime & Crime Victims Research and Treatment Center, 1992). The movie picks up 2 weeks after the gang rape (not the required 4 for diagnosis of PTSD). I Spit on Your Grave – also released as Day of the Woman – is a case study of the two-thirds incidence. Following the traumatic event, Jenny doesn’t quite display symptoms from the four symptom clusters: a) intrusion, b) avoidance, c) negative alterations in cognitions/mood, and d) alterations in arousal and reactivity. While Jenny demonstrates constricted affect and anger (Criterion C), she’s sincerely focused on her plan for revenge. Her aggressive behavior therefore is likely the result of cortical executive function, and not an alteration in subcortical processes such as arousal and reactivity. Given the poised way she proceeds with her plan, Jenny’s behavior is not considered reckless.

Perhaps what I Spit on Your Grave best illustrates is the very reason why movies serve as a robust medium to teach psychopathology. Movies are a safe platform/milieu for viewers to embrace their id without having to abide by the superego’s reality principle. Through the ego defense, identification, we can subconsciously take part in acts that are culturally taboo such as those depicted in one of the most ridiculously violent movies of all time.

Key Words: I Spit on Your Grave, Day of the Woman, Jennifer Hill, Posttraumatic Stress Disorder, PTSD, Cabin in the Woods, id, superego, reality principle, ego defense mechanism, identification

Next week’s movie: The Amityville Horror (1979)

Movie of the week: The Amityville Horror (2005)

Last week’s movie: I Spit on Your Grave (1978)

Synopsis

The Amityville Horror is a 2005 remake of the 1979 horror film which itself was based on a novel of the same name by Jay Anson. The film chronicles the life of George and Kathy Lutz and their family after they move into a haunted house on Long Island. The house at 412 Ocean Ave. was previously the grizzly scene of a mass homicide committed by Ronald (Ronnie) DeFeo, Jr. who murdered six members of his family on November 19, 1974.

Due to external constraints, this post will focus on the most recent screen adaptation and not the 1979 original film. Despite the film being a traditional “haunted house story,” we learn that The Amityville Horror is about demonic possession when Kathy researches microfiche and discovers “voices told him (Ronnie Defeo) to do it.” After moving into the basement, he “killed them all” just 28 days later (a timeframe also forecasted in Richard Kelly’s 2001 film, Donnie Darko). The movie references The Shining and Hellraiser (1987) when Kathy discovers that native Americans were tortured (there are pictures of Clive Barker-esque torture) in a secret room in the basement. The torturer suicided by slitting his throat so that his presence would live forever, thus explaining the spirit possession of George’s body.

How it relates to the field of psychiatry

At Rutgers Robert Wood Johnson Medical School, the first module, Necromancy, of our year- long resident Psychopathology course incorporates ghosts (wraiths) and demons. As discussed in my Week 5 blog, tales of demonic possession serve to reinforce teaching points of chronic and persistent illnesses. Movies about demonic possession may therefore be metaphorically interpreted as case studies of psychosis. In that same Week 5 post, the Warrens ended the movie, The Conjuring, with the discovery of a new haunted house; one we now also investigate from an educational perspective.

The scene of “the DeFeo murders” in Amityville is haunted by the ghosts of the victims. We learn that Chelsea, the youngest daughter of the Lutzes, has an imaginary friend, Jodie. Similar to Stephen King’s The Shining, our provisional thought is that this is developmentally appropriate. However, like Danny Torrence, Chelsea’s behavior becomes maladaptive, and her perceptual disturbances are ultimately deemed not to be age-appropriate. In one scene, we visit the archetypal warning of inappropriate conduct when supervising children; the “bad babysitter.” This archetype - which we will revisit in Scream, Halloween, and Friday the 13th – is a prosocial warning that is violated by Lisa, who is attacked by Jodie and rendered catatonic. As a tale of demonic possession, George Lutz begins to demonstrate delusions of passivity. He suffers from thought insertion when he succumbs to the delusion that he’s not in control of his own behavior. “All that is psychotic is not schizophrenia” however. In George’s case, schizophrenia is unlikely, given the atypical characteristics of his presentation. Delusions of passivity are no longer considered first-rank quality (DSM-5), thus allowing for a broader differential diagnosis. For example, in the original (1979) film, emphasis is placed on George’s struggle with his faith, perhaps a predisposing factor of his psychosis. In a stress-diathesis model, his psychotic break results from the precipitant of his move to a house that is the scene of the infamous DeFeo murders.

Key Words: Amityville Horror, George Lutz, Kathy Lutz, Ronald DeFeo, The Shining, Hellraiser, Scream, Halloween, Friday the 13th, delusion of passivity, thought insertion

Next week’s movie: Mr. Jingles (2006)

Movie of the week: Mr. Jingles (2006)

Last week’s movie: The Amityville Horror (1979)

Synopsis

After visiting the Amityville Horror house with the Warrens, we take a ferry ride across Lake Eerie Erie to visit the Wolverine State. The following synopsis reflects the 2006 horror movie as well as its sequel, Jingles the Clown, a 2009 reboot directed by Tommy Brunswick and written by Todd Brunswick. Charles David Tanner is Mr. Jingles, a serial killer and the co-host of a children's television series. Mr. Jingles already tortured and murdered 31 people by the time he abducts the Nelson family, and forces nine-year-old Angela (Angie) to watch as he films himself murdering her parents and sister. The police arrive in time to rescue Angie. Instead of arresting Jingles, they execute him, disposing the body in the trunk of a police cruiser. As Angie is led away, Jingles winks at her. In true Pennywise fashion (see below), Jingles escapes down a septic tank.

In the 15 years that have passed, Tanner’s home has become an urban legend for teens to dare to visit, and ghost hunters to investigate. The film depicts the events of Miranda and her cast of Haunted Maniacs who dare to investigate the truth behind the urban legend of Mr. Jingles.

How it relates to the field of psychiatry

The archetype of the “killer clown” has its roots in both horror fiction and forensic psychiatry. Fictional accounts build on the universal fear; coulrophobia. In a more general sense, it’s a twist on the double bind. A child receives two conflicting messages; a funny character whose behavior is entertaining, but whose thoughts are dark and sinister.

Angie Nelson’s homecoming is homage to the “Losers Club” who as adults, return to their hometown of Derry, Maine in Stephen King’s IT. Angie’s dissociative amnesia prevents the film crew from finding the talisman needed to ward off Jingles. Cued by information in the case files, Angie recalls an old trunk in the attic which sets the scene for the movie’s climax. Similarly, Stephen King’s 1984 novel depicts five accounts of Dissociative Amnesia. In the second part of the book, the “five Losers” return to Derry with a collective inability to recall information about the traumatic events related to their earlier battle with Pennywise the clown. The protagonists’ fight through their memory deficits pushes the narrative forward to the novel’s climax deep in the sewers of Derry.

In addition to teaching points pertaining to Dissociative Amnesia, Mr. Jingles also allows for review of sociopathy. An alderman in Chicago, John Wayne Gacy, Jr. (aka the “Killer Clown”) was convicted of murdering a minimum of 33 people in a series of killings committed between 1972-1978 (Charles David Tanner – ironically also of 3 names – murdered about the same number of people in Jingles). Gacy gained high status in community circles and joined a "Jolly Joker" clown club whose members would regularly dress as clowns and voluntarily entertain hospitalized children. Pogo was Gacy’s alter ego whose sinister motives could be literally seen on his face in that his makeup created sharp points (painted smile). Conversely, clown makeup always creates curved or soft contours as a non-verbal extension of friendship to the children they entertain. Similar to Gacy creating his own performance character, “Pogo the Clown,” Tanner co-hosted a children's television series as Jingles the Clown.

The roots of coulrophobia can be traced back to June 22, 1918, when 86 circus performers were killed and buried in a mass grave at Showman’s Rest in Chicago. Clown scares in 1980 (Newark, NJ) and 1981 (Evil Phantom Clowns of Boston) rekindled cinematic intrigue that was reflected in Poltergeist (1982) and IT (1984). The clown hysteria came full circle with its return to Chicago with the Clown Panic of 1991 in Cabrini Green (“The Evil Homey”).

Key Words: Mr. Jingles, Jingles the Clown, Pennywise, Stephen King’s IT, Haunted Maniacs, killer clown, coulrophobia, double bind, Angie Nelson, Losers Club, dissociative amnesia, sociopathy, John Wayne Gacy, Charles David Tanner, Jolly Joker, Pogo, Showman’s Rest, Evil Phantom Clowns, Poltergeist, Cabrini Green, The Evil Homey

Next week’s movie: The Giant Spider Invasion (1975)

Movie of the week: The Giant Spider Invasion (1975)

Last week’s movie: Mr. Jingles (2006)

Synopsis

The Giant Spider Invasion is a 1975 film about colossal arachnids that terrorize a small Wisconsin town. At about 20 minutes into the movie, characters discuss the ferry over Lake Michigan. We take the virtual boat trip from Michigan – where we visited Mr. Jingles – to Wisconsin where we’re introduced to the community of Gleason when a giant meteor hits earth. The disaster creates a black hole that serves as portal for giant spiders from deep space to invade our planet. Despite its rating of 2.8 on IMDb, the film is listed on 'The 100 Most Enjoyably Bad Movies Ever Made.'

How it relates to the field of psychiatry

The movie begins with our learning of Dan and Ev Kester’s maladaptive relationship. Dan often berates his wife that she’s “hitting the booze again.” She replies that she feels terrible and reports seeing “big black hairy spiders.” Taken together, the film serves as a metaphor for Alcoholic Hallucinosis (AH). Given Ev’s clear sensorium, her “seeing spiders” is less likely to be due to Alcohol Withdrawal Delirium (delirium tremens, DT’s), making AH the most likely diagnosis.

The Giant Spider Invasion also serves as a teaching tool in two additional capacities. First, the iconic theatrical poster art is a throwback to the giant monster movies of the 1950’s. This, referenced in Joss Whedon’s Cabin in the Woods as “Giant,” links to specific mental illnesses such as the dissociative disorders (Stay-Puft Marshmallow Man), separation anxiety disorder (Cloverfield), and pyromania (Godzilla). [Of note, in addition to Godzilla, radioactivity from space also played an etiologic role in Night of the Living Dead, but we’ll discuss that in more detail on February 6].

The geography of our itinerary plays a direct role in the final teaching point. The current movie coming after Mr. Jingles sets up back-to-back states that depict common objects of specific phobias; clowns and spiders. Interestingly, while Mr. Jingles is a homage to Stephen King’s IT, a giant spider is the earth-bound form of that novel’s eponymous shape-shifter.

Key Words: The Giant Spider Invasion, Alcoholic Hallucinosis, Alcohol Withdrawal Delirium, delirium tremens, DT’s, Joss Whedon, Cabin in the Woods, dissociative disorders, Stay-Puft Marshmallow Man, Ghost Busters, separation anxiety disorder, Cloverfield, pyromania, Godzilla, specific phobia, Night of the Living Dead

Next week’s movie: Jennifer’s Body (2009) Movie of the week: Jennifer’s Body (2009)

Last week’s movie: The Giant Spider Invasion (1975)

Synopsis

Jennifer’s Body (2009) is a black comedy that takes place in Devil’s Kettle, a Wisconsin town named after an anomaly of nature. The movie chronicles the exploits of Jennifer Check, her BFF Anita “Needy” Lesnicki , and their infatuation with a cryptic indie rock band (Low Shoulder).

The film’s setting; a town named after a waterfall with a whirlpool is homage to Homer’s Scylla and Charybdis. Being “between Scylla and Charybdis” is an idiom derived from Greek mythology, meaning having to choose between two evils. The town’s name then is symbolic of the teenage angst that defines the relationship between its two principle residents.

How it relates to the field of psychiatry

At Rutgers Robert Wood Johnson Medical School, the first module – titled Necromancy – of our year-long resident Psychopathology course incorporates ghosts (wraiths) and demons. While the former references disorders that are episodic in nature, tales of demonic possession serve to reinforce teaching points of chronic and persistent illnesses such as the Dissociative Disorders.

Jennifer’s Body may be viewed as a case study of Dissociative Identity Disorder, the hallmark characteristic of which may be described in some cultures as an experience of possession (DSM- 5). The film introduces the notion of demonic transference, an untoward consequence of a virgin sacrifice gone wrong. Since Jennifer lost her virginity in junior high, a demon will possess her soul. Jennifer’s body will therefore forever feed on flesh. She describes herself as a different person - disruption of identity - when she doesn’t feed.

The Dissociative-Eating Disorder Continuum

The movie’s ending parallels that of Carrie, and therefore may be viewed in the context of the Eating and Feeding Disorders (see our Week 1 blog). During the climax at the dance (similar to Carrie’s prom), its disclosed that Jennifer abuses laxatives. Her misuse of cathartics defines purging behavior that may be seen in Anorexia Nervosa or Bulimia Nervosa.

The Eating Disorder-Borderline Personality Disorder Continuum

One sign of an eating disorder is a disturbance in the way in which one’s body weight or shape is experienced. This quality is shared with Borderline Personality Disorder (BPD). Interestingly, Jennifer demonstrates many characteristics that define BPD: unstable self-image; dissociative states under stress (“I feel so empty” said to Chip in the pool scene); lack of empathy (laughing at the death of Melody Lane patrons); intense, unstable intimate relationships; and self-injurious behavior (burning tongue, cutting). The Dissociative-Eating-Borderline Personality Disorder Continuum

Some clinicians conceptualize the DID-Eating Disorder-BPD continuum as Posttraumatic Stress Disorder (PTSD). After Jennifer and Needy narrowly escape a horrific fire, Jennifer leaves with the band and is sacrificed at a satanic ritual. Since the fire, Needy demonstrates evidence of PTSD with perceptual disturbances, the first of which is seeing a carnal Jennifer previously thought to be dead. She also describes herself as numb, consistent with feelings of detachment and an inability to experience positive emotions that define PTSD.

The film therefore allows for discussion of Posttraumatic Stress Disorder in both of its main characters. After Jennifer and Needy narrowly escape a horrific fire, Jennifer leaves with the band and is sacrificed at a satanic ritual. Despite her name representing Dependent Personality Disorder, Needy begins to demonstrate evidence of PTSD as evidenced by perceptual disturbances (the first of which is seeing a carnal Jennifer previously thought to be dead). She also describes herself as numb, consistent with feelings of detachment and an inability to experience positive emotions.

Finally, Needy likens Nikolai to the twisted petrified tree she saw as a kid. While Jennifer’s Body takes place in Wisconsin, perhaps Needy grew up in Bernards Township, NJ where locals tell the urban legend of The Devil’s Tree. There are many stories (http://weirdnj.com/stories/devils-tree/) about the origin of the petrified oak including human sacrifices and a portal to hell.

Key Words: Jennifer’s Body, Devil’s Kettle, Low Shoulder, Scylla and Charybdis, Necromancy, Dissociative Disorders, Dissociative Identity Disorder, virgin sacrifice, demonic transference, Carrie, Eating and Feeding Disorders, Anorexia Nervosa, Bulimia Nervosa, Borderline Personality Disorder, Dependent Personality Disorder, Posttraumatic Stress Disorder, PTSD, Bernards Township, The Devil’s Tree.

Next week’s movie: Leprechaun (1993)

Movie of the week: Leprechaun (1993)

Last week’s movie: Jennifer’s Body (2009)

Synopsis

On January 10, 1983, Daniel O’Grady returned home from a trip to Ireland and told his wife that he had captured a Leprechaun and that by doing so, acquired his pot of gold. Mrs. O’Grady is mysteriously killed, and Dan is institutionalized upon after discovering the body of his dead wife.

Leprechaun is a 1993 horror comedy that details the exploits of Tory Redding and her friends 10 years later, when her father moves them into the O’Grady farmhouse. Tory must battle the curse of the leprechaun by enlisting the help of Nathan Murphy, his little brother Alex, and their friend Ozzie Jones.

How it relates to the field of psychiatry

While the name “leprechaun” is derived from the Irish leath bhrogan (shoemaker), origins of the folkloric cobbler lie with the fae (fairy). From the lineage of supernatural creatures that includes elves, gnomes and trolls; leprechauns are guardians of treasures buried during war-time. They hide their gold in secret locations which can only be revealed if a person, such as Daniel O’Grady, is fortunate enough to capture one of the folkloric creatures.

The film opens with the eerie fairy prophesying, “Try as they will, and try as they might, who steals me gold won't live through the night.” Capturing the leprechaun’s pot of gold at the end of the rainbow is both literally and figuratively a Sisyphean task. In the literal sense, rainbows result from the dispersion of light through individual droplets of water that act as tiny prisms. The droplets disperse the light and reflect it back to the viewer’s eye. An observer on the ground sees a half-circle of color. However, when viewed from above the ground, the rainbow is actually discovered to be a complete circle, making the discovery of a pot of gold at the end of a rainbow a physical impossibility.

Finding gold at the end of the rainbow is therefore parallel to achieving self-actualization in a Maslowian pyramid; something we continually strive for, but never fully achieve. The character of Daniel O’Grady, as well as all those who follow in taking the leprechaun’s gold, is then the embodiment of hubris. Driven by pride and greed, the characters in Leprechaun will bear its curse.

Similar to the Norse mythological creatures of dwarves and trolls (faes), another Norse hero’s tale is also shrouded in greed for gold. In Beowulf (2007), King Hrothgar's mead hall, Heorot, is under siege by the legendary Grendel. The reason for the monster’s assault is the king’s possession of a golden horn, a symbol of pride and lust (before committing suicide, Hrothgar tells Beowulf that he was seduced by the water demon and that Grendel was the progeny of their tryst).

The 1993’s film’s eponymous character also demonstrates disregard for and violation of other’s rights; the hallmark of Antisocial Personality Disorder. His character is a reincarnate of Count Dracula, who violates Jonathon Harker’s rights when he imprisons the wayward lawyer in his castle. Beyond Tory’s complaining that the farmhouse’s previous owner was Dracula, the leprechaun parallels the vampire in that it is considered soulless (traded his soul for the gold), and withdraws from a four-leaf clover much like a vampire reacts to a crucifix.

“I'll not rest till I have me gold. Curse this well that me soul shall dwell, till I find me magic that breaks me spell.”

Key Words: Leprechaun, leath bhrogan, fae, fairy, elf, gnome, troll, Sisyphean task, self- actualization, Maslow, Beowulf, King Hrothgar, Heorot, Grendel, Antisocial Personality Disorder, Count Dracula, Jonathon Harker.

Next week’s movie: Alien Abduction: Incident in Lake County (1998)

Movie of the week: Alien Abduction: Incident in Lake County (1998)

Last week’s movie: Leprechaun (1993)

Synopsis: Alien Abduction: Incident in Lake County is a larger-budget version of The McPherson Tape which originally aired on UPN on January 18, 1998. Despite The Blair Witch Project (our February 27 destination) having been credited with the ‘found footage’ explosion, Alien Abduction actually predates Sánchez and Myrick’s work. Alien Abduction is presented as a video tape made by Tommy, a teenager in Lake County, Montana, during his family's Thanksgiving dinner. This week’s 52in52 blog will focus on Tommy and his family’s close encounter with an alien invasion as well as the original mockumentary which is purported to be from the Northwoods, Connecticut U.F.O. Case 77.

How it relates to the field of psychiatry

Classified as “Alien Beast” on Joss Whedon’s Big Board in Cabin in the Woods (2012), the alien invasion/abduction subgenre captures our culture’s universal fear of the unknown. This archetypal fear can be traced as far back as the 17th-century when Charles Perrault wrote his folkloric tale, Le Petit Chaperon Rouge (Little Red Riding Hood), a prosocial warning not to wander into the unknown. Its alien inclusion occurred in 1938, when H. G. Wells’s novel, The War of the Worlds, was broadcast on radio on “Mischief Night” (October 30). The beginning of the radio drama was presented as a series of news bulletins reporting the invasion of Martians. Similar to the radio broadcast by Orson Wells, which threw the town of Grover’s Mill, NJ into widespread paranoia, The McPherson Tape also created controversy, as it was created to appear as a genuine home video.

Like the zombie, alien beasts evolve along with a culture’s fears. Therefore, a post-World War II variation of the “unknown” theme includes the idea that “they are among us.” This is depicted in Who Goes There?, a novella by John Campbell that was adapted to the screen as The Thing from Another World (and remade in 1982 as John Carpenter's The Thing). In Carpenter’s film, members of an Antarctic research station battle an alien life form that was awakened from its dormancy deep within the ice. Since the alien can assimilate at the molecular level, the researchers grow paranoid of each other, any one of whom can be the alien, phenotypically disguised.

This week’s movie also depicts extreme denial best demonstrated by the family’s intention to leave the house - “will you be by tomorrow for breakfast?” - despite just having spotted a “gray” in their backyard. Men in Black (1997) merges this ego defense with the above “they are among us” theme: “There’s always an Arquillian Battle Cruiser, or a Corillian Death Ray, or an intergalactic plague that is about to wipe out all life on this miserable little planet, and the only way these people can get on with their happy lives is that they Do… Not… Know about it!” (Agent K). Another ego defense, dissociation, is manifested by Rene (then the grandmother) when she’s describes, “Like you were sleepwalking” and doesn't remember how she got from the kitchen to the door. Interestingly, it is during one of these dissociative episodes that the grandmother attempts to open the door for the aliens (paralleling having to invite a vampire into the home). This scene further pushes the “aliens are among us” narrative forward as it implicates “us” as an active participant in our own demise (abduction).

The film ends with an announcement to contact 800-555-7070 with any information of the McPhersons’ whereabouts.

Key Words: Alien Abduction: Incident in Lake County, The McPherson Tape, The Blair Witch Project, Connecticut U.F.O. Case 77, Alien Beast, Joss Whedon, Cabin in the Woods, Charles Perrault, Le Petit Chaperon Rouge, Little Red Riding Hood, H. G. Wells, The War of the Worlds, Mischief Night, Devil’s Night, Grover’s Mill, Who Goes There?, John Campbell, The Thing from Another World, John Carpenter, The Thing, Men in Black.

Next week’s movie: Idaho Transfer (1973)

Movie of the week: Idaho Transfer (1973)

Last week’s movie: Alien Abduction: Incident in Lake County (1998)

Synopsis

Set at an unknown government facility near the Craters of the Moon lava fields, Idaho Transfer is a film about Karen Braden and a group of teenagers who take part in a top secret project commissioned to develop matter transference. During the project’s inception, 2 amazing discoveries are made: a) a mysterious ecological catastrophe will soon wipe out civilization and b) time travel is possible. Unfortunately, adults “not much older than 20” are unable to survive time travel, as hemorrhagic nephritis is found to be an untoward outcome.

Met with this harsh reality, the group of teenagers is sent 56 years into the future so they can build a new civilization. After the government takes over the project, the transfer machines are shut down, trapping a large number of subjects in the future. Armed only with the hope of a brave new world, the primordial teens set out to explore their future dystopian hellscape.

How it relates to the field of psychiatry

Karen has a past medical history significant for an undisclosed mental illness as evidenced by her recent discharge from a mental health outpatient clinic. Her mental disorder may be associated with sexual trauma (with the disclosure that she was raped). She also demonstrates significant egocentrism throughout the film, despite the primary directive of their project being incredibly altruistic (to repopulate the earth). Believing she is pregnant, Karen manifests secondary amenorrhea. Taken together, Idaho Transfer may be a film profiling a main character with an Eating and Feeding Disorder, rule out Anorexia Nervosa. Following the death of her sister, Isa, Karen describes herself as “just blank.” Karen's reaction to Isa's death is consistent with Posttraumatic Stress Disorder (PTSD). Her constellation of symptoms highlights the fact that individuals who develop eating disorders after sexual trauma are likely to have experienced PTSD symptomatology.

Once trapped in the future, the teenagers come across a group of second- and third-generation survivors who have regressed back to a Stone Age existence. The survivors are deaf and are unable to speak (alogia). The 2 groups are similar in that while there’s new hope with the discovery of the Stone Age people, everyone is metaphorically blind to what the future truly holds. They differ from Karen’s group in that they live “hand to mouth” and want little more. Interestingly, Idaho Transfer shares a common plot with another 70’s work about a “deaf, dumb, and blind” kid, Tommy.

The film, Tommy (1975), is a rock opera based upon The Who's 1969 concept album, Tommy. After being pushed into a mirror, Tommy has a vision in which people obtain enlightenment by playing pinball. He attracts millions of followers to his new order, much like the group of teenagers in Idaho Transfer plan to create a new world. Tommy’s ultimately denouncing his new-founded “religion” parallels the teenagers’ discovery that, in addition to hemorrhagic nephritis, time travel also causes sterility (this further supports Anorexia Nervosa as the most likely reason for Karen’s secondary amenorrhea). Karen, her peers, and Tommy ultimately abandon their respective objectives.

Key Words: Idaho Transfer, Craters of the Moon, matter transference, hemorrhagic nephritis, egocentrism, altruism, Eating and Feeding Disorders, Anorexia Nervosa, amenorrhea, Posttraumatic Stress Disorder, PTSD, alogia, Tommy, The Who.

Next week’s movie: Carnival of Souls (1962; 1998)

Movie of the week: Carnival of Souls (1962; 1998)

Last week’s movie: Idaho Transfer (1973)

Synopsis

Perhaps best known for its organ score (Gene Moore), Carnival of Souls is a black and white cult classic about the hardships of Mary Henry after she survives a near-fatal car crash. The movie was inspired by a chance encounter with the abandoned Saltair Pavilion, and revolves around its creepy fictional analogue on the shores of the Great Salt Lake.

How it relates to the field of psychiatry

Following a motor vehicle accident where her two friends are killed, Mary is described as “behaving strangely” with a flat affect. A provisional diagnosis of Posttraumatic Stress Disorder (PTSD) is further supported by depersonalization (described by a priest as having a lack of soul when playing the church organ) and nightmares (dream sequence when ghouls join The Man in chasing Mary to a bus station only to find that all the passengers are ghouls).

As the plot unfolds, an expanded differential diagnosis emerges like ghouls from the Great Salt Lake. The onset of mental illness is often formulated with “the 4 P’s:” predisposing (vulnerability), precipitating, and the interaction of perpetuating and protective factors. The following paragraphs frame Mary’s behavior in the context of 3 of these factors.

Predisposing: Mary tells a physician, “I have no desire for the close company of other people.” When questioned further, she discloses that she’s always felt this way. The stability of these feelings suggests that it’s a personality trait; her detachment from social relationships being a cardinal feature of Schizoid Personality Disorder.

Precipitating: Schizoid Personality Disorder confers an independent risk of developing Schizophrenia. The fact that Mary begins to experience “bizarre” (disorganized) behavior, delusions, and hallucinations following the accident illustrates the two-hit hypothesis; manifestation of psychotic symptoms in a generically susceptible individual upon exposure to a social stressor.

Perpetuating: Mary’s social isolation contributes to the persistence of her symptoms. While speeding along a deserted stretch of road, a ghoulish, pasty-faced figure replaces her reflection in the passenger window. Mary’s experience is an example of an autoscopic hallucination, where she sees a perceptual disturbance of her own physical self, changed. This syndrome may be seen in psychotic disorders, further supported by Mary’s delusional belief that she has to go to the pavilion.

In addition to Mary’s symptomatology, Linden demonstrates psychopathology that may be induced by Alcohol Use Disorder. While his supportive role status obfuscates pertinent details of his history, we at least know he would screen positive (CAGE questions), given the scene when he tries to share an “eye opener” with Mary.

SPOILER ALERT: In the movie’s final scene, the car is finally located and pulled from the water, revealing Mary's body in the front seat alongside the other two girls.

Key Words: Carnival of Souls, Gene Moore, Saltair Pavilion, Great Salt Lake, Posttraumatic Stress Disorder, PTSD, depersonalization, Schizoid Personality Disorder, schizophrenia, autoscopic hallucination, Alcohol Use Disorder, CAGE, eye opener.

Next week’s movie: Close Encounters of the Third Kind (1977)

Movie of the week: Close Encounters of the Third Kind (1977)

Last week’s movie: Carnival of Souls (1962)

Synopsis

Close Encounters of the Third Kind depicts the events of Roy Neary, an electrical lineman, who experiences an irresistible impulse to visit an isolated area that he receives in a vision after an encounter with UFOs. In planning our 52in52 itinerary, I should have visited Wyoming before Montana (Alien Abduction: Incident in Lake County, 1998) to remained loyal to J. Allen Hynek’s classification of close encounters with aliens. In ufology, the 3rd kind of encounter is defined when an animated creature is present while the 4th kind is an event in which a human(s) is abducted as the McPhersons were in Week 12.

How it relates to the field of psychiatry

Two iconic monsters that represent our culture’s fear of the unknown are the Zombie and Alien Beast. While zombies relate to Mood Disorders (but we’ll have to wait 2 weeks for The Crazies), this week’s film highlights aliens and their role in reviewing Bipolar and Related Disorders.

We are first introduced to Roy Neary and his family around the dinner table during a discussion of their planning a family event. Roy’s insistence on seeing Pinocchio is characterized by irritability and verbally abusive language. While we aren’t provided a recent history that allows us to determine if his behavior is a change from previous functioning, the events that will unfold will frame this early scene as a prodrome to mania.

Following a close encounter with UFOs (rule-out perceptual disturbance) while in his truck, Roy’s behavior becomes erratic, and results in significant impairment in interpersonal (his wife and children leave him) and occupational (he is fired from his job) functioning. Initially, he becomes obsessed with a vision he receives. His belief that he must visit an isolated area in the wilderness to see something spectacular becomes fixed. His grandiose delusion is initially mood- incongruent when he experiences a major depressive episode culminating in his crying inconsolably in the shower. Thereafter, Roy switches to the opposite pole and manifests grandiosity, a decreased need for sleep, pressured speech, and an increase in goal-directed activity in constructing an 8-foot replica of Devil’s Tower in his living room (the precipitant for his wife leaving him).

It is unclear to the audience if the people Roy meets who confirm his reality are themselves products of his own mind. When such is the case in film, it’s interesting to uncover aspects of the movie that are physically impossible, therefore supporting the notion that only in one’s mind can the events be rationalized.

Type I error: Supporting a diagnosis of Bipolar Disorder Type I error (interestingly called error of the first kind) is the conclusion that a supposed effect exists when in fact it doesn’t. Stated differently, something is added to the film the supports the notion that the people that Roy meets are a product of his own mind. In the climactic scene at the end of the movie, the alien mothership flies over Devil’s Tower. We see the ship’s shadow creeping along the ground despite the fact that there’s no light source above the ship. Conversely, when the brightly lit alien mothership passes directly over Devil's Tower, the rock formation remains dark despite having the leviathan light source directly above.

Type II error (almost): Supporting a diagnosis of Bipolar Disorder

Type II error (interestingly called error of the second kind) is the conclusion that something does not exist when in fact it does. Stated differently, something is removed or is missing from the film the supports the notion that the people that Roy meets are a product of his own mind. For example, Roy’s joining the aliens is critical in realizing that his behavior is significantly impacted by his delusions. Despite this, Spielberg has expressed that if he were to make the movie over again, he would delete this scene. Additionally, Spielberg intended to cut the entire manic (garden) episode from the Special Edition despite it arguably being the most defining scene in the movie.

Key Words: Close Encounters of the Third Kind, Alien Abduction: Incident in Lake County, J. Allen Hynek, Zombie, Alien Beast, Bipolar and Related Disorders, mania, mood-incongruent, Devil’s Tower, Type 1 error, alpha error, Type 2 error, beta error.

Next week’s movie: Badlands (1973)

Movie of the week: Badlands (1973)

Last week’s movie: Close Encounters of the Third Kind (1977)

Synopsis

Badlands is an American crime drama that is loosely based on Charles Starkweather and his 14- year-old girlfriend, Caril Ann Fugate, who killed 11 people during their month-long murder spree in Nebraska (1958). The movie received critical acclaim, building on Starkweather’s place in history as captured in Billy Joel’s We Didn’t Start the Fire:

Little Rock, Pasternak, Mickey Mantle, Kerouac Sputnik, Chou En-Lai, Bridge On The River Kwai Lebanon, Charles de Gaulle, California baseball Starkweather, Homicide, Children of Thalidomide...

Unlike Badlands, The Frighteners (1996) focuses on the supernatural in featuring a Starkweather-inspired killer who goes on a similar spree with a kidnapped female accomplice. In this way, The Frighteners is similar to Saw (2004), Hostel (2005), and the movie we’ll watch on June 5, The Ring (2002), as all are inspired by real life (serial and spree) killers.

How it relates to the field of psychiatry

Movies such as Badlands serve to review salient features of antisocial personality and related disorders. Antisocial Personality Disorder (APD) is defined by a pervasive pattern of disregard for and violation of others’ rights in a person 18 years of age or older. APD is the only personality disorder with an age requirement and underscores a critical aspect of the film; as Kit is 25 and 10 years older than Holly. When Holly’s father disapproves of Kit being around his daughter, Kit commits the most egregious violation of another’s right and shoots him.

Sociopathy versus Psychopathy

Two terms often used interchangeably with APD are sociopathy and psychopathy. While sociopathy and psychopathy appear to result from the same biopsychosocial determinants that cause APD, efforts to define and differentiate these conditions have been inconsistent. At this time, it is arbitrarily agreed upon that both are aggressive forms of APD. Sociopathy is hallmarked be an element of sadistic pleasure, while psychopathy describes conscienceless killers who appear to show no human feeling for their victims. Kit appears to be a psychopath, demonstrating signs beyond what we would expect from APD (i.e. not DSM-5 criteria) including manipulativeness (Kit never signs his name the same way twice), episodic relationships (Kit tells Holly’s father he’s never really had a girlfriend), emotional shallowness (Kit calls Holly ‘stupid’ right after she loses her virginity to him), and glibness (Holly follows Kit on his murder spree after Kit kills her father). Key Words: Badlands, Charles Starkweather, Caril Ann Fugate, Billy Joel, We Didn’t Start the Fire, The Frighteners, Saw, Hostel, The Ring, Antisocial Personality Disorder, Sociopathy, Psychopathy, spree, mass murder

A “murder spree” is defined when someone (or a couple) kills a number of people “in spurts” over a relatively short period of time. The term “mass murder” is used when 4 or more people are killed at one time. These scenarios remind us of the complexity of human behavior in general, and of antisocial behavior in particular. For example, most spree killers and mass murderers die by suicide; either by their own hand or that of law enforcement (“death by cop”). SPOILER ALERT: Kit’s murder spree ends with his deciding to forgo escape and give himself up. He shoots his front tire and awaits the police to arrive, and doesn’t put up any resistance despite knowing he’ll be executed.

Next week’s movie: The Crazies (2010)

Movie of the week: The Crazies (2010)

Last week’s movie: Badlands (1973)

Synopsis

The Crazies is a 2010 remake of the 1973 horror film of the same name by George A. Romero. The film takes place in the fictional Iowa town of Ogden Marsh Township, the “friendliest place on earth,” and portrays an epidemic caused by the Trixie virus. The town sheriff’s attempts to control the water-borne virus are thwarted by the Ogden Marsh Township mayor who, similar to the mayor of 1975 Amity Island (see our post on July 25), decides the “water stays open on.”

How it relates to the field of psychiatry

The Crazies (discriminatory use of the word notwithstanding) serves as an opportunity to review the case formulation of psychosis, rule-out Schizophrenia. Here, we’ll define psychosis by a) negative symptoms (e.g. flat affect) and b) positive symptoms such as delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.

Positive Symptoms of Schizophrenia

Positive symptoms are clinical findings deemed to be abnormal when they are present. In an initial scene, Rory presents with bizarre speech and behavior when he walks onto a little league field in a catatonic state that is described as “appearing drunk.” After he’s shot, the medical examiner (ME) orders a blood alcohol level (BAL) and toxicology screen to see if Rory’s behavior is due to the direct physiological effects of a substance. This early scene establishes that consideration of a substance- or medication-induced psychotic disorder is integral in the initial work-up of new-onset psychosis.

Negative Symptoms of Schizophrenia

Negative symptoms are clinical findings deemed to be abnormal when there’s an absence of something that normally should be present. Soon after, Bill presents to Judy, his primary care physician (PCP), for evaluation of disorganized speech (non sequiturs and perseveration) and behavior. In addition to these positive symptoms, Bill also presents with a flat affect. The absence of normal (affective) intensity characterizes a flat affect as a negative symptom. Judy’s treatment plan includes a CT scan of the head. Her formulation is accurate in that one must consider an underlying general medical condition (GMC) as the cause of psychosis before attributing it to mental illness (such as Schizophrenia).

Unfortunately, Bill’s bizarre behavior culminates in his setting his house on fire. Interestingly, both of these cases foreshadow the cause of the zombism depicted in The Crazies. The ME’s provisional diagnosis of a substance-induced psychotic disorder is accurate when it’s ultimately discovered that the etiology is a weaponized virus (toxin-induced). In a similar context, the discovery of the Trixie virus also allows for the conceptualization of a viral syndrome (i.e. due to a GMC) as the underlying cause. After an incubation period of 48 hours, the virus gradually induces a psychotic state in infected individuals.

The original version of The Crazies (1973) demonstrates a deliverance from the counterculture of the 60’s with its depiction of “normal” people from the “friendliest place on earth” turned into perpetrators of violence. The zombies therefore are not true zombies, but living people turned zombie-like (Vuckovic, 2011). As such, like all zombie films, its message mirrors the theme of the decade also reflected in Let’s Scare Jessica to Death (1972), Shivers (1975), and Blue Sunshine (1977).

Key Words: The Crazies, George Romero, Ogden Marsh Township, Trixie virus, psychosis, schizophrenia, negative symptoms, positive symptoms, Jovanka Vuckovic, ZOMBIES! An Illustrated History of the Undead, Let’s Scare Jessica to Death, Shivers, Blue Sunshine

Next week’s movie: Halloween (1978)

Movie of the week: Halloween (1978)

Last week’s movie: The Crazies (2010)

Synopsis

Halloween begins with six-year-old Michael Myers killing his seventeen-year-old sister, Judith, on Halloween 1963. Michael is subsequently hospitalized at Smith's Grove Sanitarium. Fifteen years later, he escapes and returns to his hometown where he stalks the people of Haddonfield. The film is set in Haddonfield, Illinois, a fictional Midwestern town that is actually an ode to co- writer, Debra Hill’s, hometown of Haddonfield, NJ.

How it relates to the field of psychiatry

Michael Myers serves as a case study of Conversion Disorder, a type of somatic symptom disorder. The common feature of the somatic symptom and related disorders is the presence of physical symptoms that suggest a general medical condition. What’s defining is that the symptom or deficit (e.g. mutism) is not fully explained by a) a general medical condition (e.g. aphonia), b) the direct effects of a substance or c) another mental disorder. Following the murder of his sister, Michael loses his ability to talk. Through the entire franchise which includes the original film, seven sequels and two remakes, Myers doesn’t utter a single word. There is no physical explanation for his motor deficit. The film and its many reproductions are illustrations of a conversion reaction stemming from the trauma of murdering his sister. Michael’s violent behavior may therefore be interpreted as nonverbal communication resulting from the defense mechanism; acting out.

The film is similar to other slasher movies such as Friday the 13th and Scream (52in52, 2/13/15 and 6/26/15) in that it depicts the prohibitions against “inappropriate babysitting.” Judith Meyers’s fate is the consequence of her having sex with her boyfriend when given the responsibility of supervising her younger brother (the stuff urban legends are made of).

Halloween serving as a case study for the somatic symptom (primary gain) and related disorders (secondary gain) allows for the discussion of Factitious Disorder versus Malingering (disorders related to the somatic symptom disorders). The urban legend of “The Halloween Sadist” inspired many literary works including Candyman, a short story by Clive Barker. The legend is about the treat of tainted candy being given out on Halloween night. The legend stems from dog biscuits given to children on Halloween on Long Island in 1964. Ronald Clark O’Brien, the “Candy Man,” used this urban legend as an alibi when he poisoned his own son by lacing a pixy stick young Timothy O’Brien got trick-or-treating with cyanide. If an external incentive (collect insurance money) motivated Ronald’s behavior, Malingering would be likely than Factitious Disorder. An interesting subplot of Halloween is that there are multiple references made to deviant sexual behaviors (paraphilias). When Michael first returns to Haddonfield, he stalks Laurie Strode. Stalking is a variant of voyeurism/voyeuristic disorder. While his motivation (sexual fantasies or urges) is unclear, Michael’s stalking behavior clearly results in Laurie’s mental distress. Later in the movie, Tommie hides behind the curtains to scare Lindsay when he sees Michael across the street carrying the body of his dead sister. The scene has voyeuristic undertones, and is similar to movies depicting peeping toms as key eyewitnesses to murder (Disturbia, Mr. Brooks, The Burbs).

In another early scene, a reference is made to an obscene phone call. Telephone scatologia is a variant of exhibitionism/exhibitionistic disorder which centers on the need to expose one’s genitals to other people (typically strangers caught off guard) in order to achieve sexual pleasure. With this subversive context, it’s no mistake that the sexually-inhibited Laurie is the only teenager to survive Michael Meyers’ vengeful rampage.

Key Words: Halloween, John Carpenter, Michael Myers, Debra Hill, Haddonfield, Conversion Disorder, somatic symptom disorder, primary gain, secondary gain, acting out, Friday the 13th, Scream, slasher, Bogeyman, The Halloween Sadist, Ronald Clark O’Brien, Candyman, Clive Barker, Factitious Disorder, malingering, paraphilias, paraphilic disorders, stalking, voyeurism, voyeuristic disorder, telephone scatologia, exhibitionism, exhibitionistic disorder, Disturbia, Mr. Brooks, The Burbs

Psycho-nicity: ‘Synchronicity’ is a Jungian term depicting the acausal connection of two or more psychophysic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. No Halloween night should be without a viewing of this John Carpenter film.

Next week’s movie: You’re Next (2011)

Movie of the week: You’re Next (2011)

Last week’s movie: Halloween (1978)

Synopsis

You’re Next is a black comedy set in an isolated location in Missouri. The plot is similar to Agatha Christie’s Ten Little Indians (1965), the film adaptation of which focuses on ten people invited to a remote location by a mysterious stranger (with Christie’s isolated snowy mountain exchanged for a cabin estate in the woods). The movies’ shared plots revolve around a series of murders from an unknown assailant(s). You’re Next demonstrates uber-dysfunctional family dynamics from its earliest scene to the disclosure of the mystery assailants.

How it relates to the field of psychiatry

The movie begins with 2 murders at a neighboring estate by unknown assailants while “Looking for the Magic” plays in the background (Dwight Twilley Band). After witnessing the cold blooded murders, we meet the Davisons, as each member arrives at a family reunion at their Missouri vacation house. The cold, uneasy interaction of the siblings begins around the dinner table when discord erupts, serving as the prelude to the first kill when Aimee’s (youngest sibling) boyfriend, Tariq, is struck by an arrow. In an attempt to secure safety, Aimee regresses, “You never give me any credit for anything...you don't believe in me,” and convinces her family that “she’s the fastest” who can reach the car and go for help. Her escape attempt ends in her running into a garrote wire outside of the front door. With 2 “loved ones” dead, the rest of the party must band together to protect themselves from the assassins cloaked in sheep, tiger, and lamb masks.

The doll-faced killers’ sinister motives are strangely balanced by the abnormal behavior of those they hunt as evidenced by Zee intimately telling Felix, “I wanna f* you on this bed next to your dead mom.” The universal fear of masked faces, depicted as ‘doll’ in Joss Whedon’s Cabin in the Woods (2012), is symbolic of the hidden agenda of “the protagonists.”

The Specific Phobia of dolls, formerly known as pediophobia, is a universal experience that likely has its roots in childhood animism. Jean Piaget posited that a child’s cognitive inability to distinguish the external from the internal world results from animism. While it’s developmentally appropriate for a child at the pre-operational stage (2-7 years) of cognitive development to believe her doll is angry, such should not be the case for the Davison children. Yet, adults universally retain memories of “their maleficent dolls,” which is why movies such as You’re Next resonate with our most primitive archetypal fears.

Crispian’s girlfriend, Erin, is identified as having been raised on a survivalist compound, and becomes the leader of the hunted. Her heroics however come at a price, reminding us that even the most peerless women and men who serve and protect are at risk for posttraumatic stress. One of the more defining scenes - “Death by Blender” - exemplifies this [Spoiler Alert] when Erin demonstrates flat and isolated affect when she reveals to Crispian that she killed Felix, “I stuck a blender in his head and killed him.”

Key Words: You’re Next, Agatha Christie, Ten Little Indians, Looking for the Magic, Dwight Twilley Band, Joss Whedon, Cabin in the Woods, Specific Phobia, pediophobia, animism, Jean Piaget, Carl Jung, archetypes, posttraumatic stress disorder, PTSD, affect

Next week’s movie: Near Dark (1987)

Movie of the week: Near Dark (1987)

Last week’s movie: You’re Next (2011)

Synopsis

Near Dark is a 1987 “hillbilly vampire” movie (Rosenbaum J, 2009) that follows Caleb Colton in a small Kansas town who becomes involved with a family of nomadic undead. The movie is about Caleb’s struggle separating from his family, and serves as a case study of the moral development of a conflicted teenager.

How it relates to the field of psychiatry

While Near Dark aims to depart from other 1980’s vampire movies such as Fright Night (1985) and The Lost Boys (1987), its central character is nonetheless a vampire, the apex predator. Inspired by Lord Byron’s Fragment of a Novel (1819), John William Polidori, a physician, conceived the vampire in his novella, The Vampyre; a Tale. Polidori’s creation, Lord Ruthven (also referenced in Byzantium, 2012), depicts a blatant disregard for and violation of other’s rights, cardinal features of Antisocial Personality Disorder (APD). Building on Polidori’s precept, Abraham “Bram” Stoker was further inspired by texts such as An Extraordinary and Shocking History of a Great Berserker Called Prince Dracula in creating Dracula in 1897. The Count’s imprisoning Jonathan Harker is further testament to the vampire serving as a metaphor for APD.

In Near Dark, the gang’s feeding frenzies depict the Freudian id guided by the pleasure principle. Their biological drive to feed is the basic Maslowian need (“A Theory of Human Motivation,” 1943), and conflicts with Caleb’s love and compassion for his sister, Sarah.

Scenes in Near Dark also reveal how horses react when approached by vampires. Such scenes underscore that horses are prey animals with “coherent” heart rates. Since their heart’s electromagnetic field (torus) is 5x that of humans, horses’ heart rates mimic humans’ who are in close proximity. The end product of these dynamics is that horses are exquisitely sensitive to human’s non-verbal communications. While vampire movies demonstrate this by having horses buck, universities such as Rutgers Robert Wood Johnson Medical School utilize horses to teach students and residents about non-verbal communication and bedside manners (https://youtu.be/MDwHOVoO12I).

Key Words: Near Dark, Fright Night, The Lost Boys, vampire, Lord Byron, Fragment of a Novel, John William Polidori, The Vampyre; a Tale, Lord Ruthven, Byzantium, Antisocial Personality Disorder, Bram Stoker, An Extraordinary and Shocking History of a Great Berserker Called Prince Dracula, Dracula, Jonathan Harker, Sigmund Freud, id, pleasure principle, Abraham Maslow, A Theory of Human Motivation, coherent heart rate, torus, Horses for Healers

Next week’s movie: Children of the Corn (1984) Movie of the week: Children of the Corn (1984)

Last week’s movie: Near Dark (1987)

Synopsis

Children of the Corn is a supernatural horror film based on a short story of the same name by Stephen King. Set in the town of Gatlin, the film tells the story of Burt and Vicky, who unwittingly uncover the sinister secret of the fictional rural town. In the town’s dissident history, the people of Gatlin turned to prayer in an attempt to ensure a successful corn harvest. What resulted was the conjuring of a strange, vengeful presence called “He Who Walks Behind the Rows.” The opening of the film is narrated by Job, 3 years in the past, and depicts a mass murder in a dinette and throughout Gatlin, Nebraska. “The harbinger” at a gas station (Cabin in the Woods, 2012) warns Burt and Vicky to take the fork in the road towards Hemingford. Despite following the road signs, the 2 “outlanders” end up in Gatlin for the ultimate battle with “He Who Walks Behind the Rows.”

How it relates to the field of psychiatry

In an early scene, Burt makes a birthday wish to live happily ever after. His wish underscores that he and Vicky represent different aspects of Wendy Darling, the mother archetype and protagonist in J. M. Barrie’s Peter Pan (1902). One of Peter Pan’s main themes is how duty and responsibility motivate human behavior. The eponymous Peter Pan goes to great lengths to avoid all adult responsibility. For example, he refuses to play father (opposite to Wendy’s mother role) to the Lost Boys. Peter’s longing to “never grow up” is a sublimation of the author who idolized children. J M Barrie also lost his 14-year-old brother in an accident. Sublimation is an unconscious process of the ego (defense mechanism) that allows for the expression of a “forbidden” impulse. Barrie befriended Sylvia Davies in London’s Kensington Park, and was enamored with her sons; George, John, and Peter. He would meet his companions daily and make up stories featuring talking birds, fairies, and pirates walking the plank.

Beyond a product of sublimation, Peter Pan also demonstrates characteristics of Antisocial Personality Disorder versus Conduct Disorder (because we don’t know his true age) as evidenced by his disregard for parents and authority. Peter’s character is paralleled by Isaac Chroner, the child who planned the mass murder of all the grown-ups in Gatlin. The Lost Boys then are represented by the children of the corn (Table 1).

In the final scene, Burt and Vicky head towards Hemingford Home with Job and Sarah (the twins, below), similar to Wendy Darling returning to England with the Lost Boys.

Table 1. Parallels Between The Lost Boys in Peter Pan and the Children of the Corn Lost Boys Description from Peter Pan Children of the Corn If Children of the Corn ended like Peter Pan… Tootles Described as the most unfortunate and Similar to how Tootles At the end of the story humblest of the band because "the big takes Smee's place as (“He wants you too, things" and adventures happen while “he has boatswain when Peter Malachai”), Malachai stepped round the corner.” He shoots Wendy takes possession of The would return to London with a bow and arrow after Tinker Bell tells Jolly Roger, Malachai with Wendy (Vicky) and them Wendy is a bird that Peter wants killed. Boardman takes Isaac’s will eventually grow up place as leader. to become a judge. Slightly Described as the most conceited of the boys Isaac Chroner is also a Unknown because he believes that he, unlike the poor make-believer, and others, remembers what life was like before meets his demise when he was "lost." However, most of his Malachai convinces the "memories" are based on misunderstandings. other children that Isaac Slightly is a poor make-believer with a “has lost favor with penchant for music. Him…they are tired of your talk.” Slightly cuts whistles and flutes from the branches of trees similar to Isaac crafting crucifixes from ears of corn. Nibs Described as happy and debonair, possibly Richard 'Amos' Deigan is Amos will grow up to the bravest Lost Boy. the only “child” who we work in an office. see offer himself the first day of his 19th year. Curly Because he always gets into pickles, Curly is Joseph also finds himself Joseph would have called “Pickle.” He isn't very smart but he’s in a pickle when grown up to work in an very loveable and has a kind heart. Malachai catches him office if Malachai didn’t trying to escape. sacrifice him in the beginning of the film. The Twins First and Second Twin know little about Job & Sarah are the only Job and Sarah will grow themselves as they are not allowed to children not in the up to work in an office. because Peter Pan does not know what cornfield when Isaac Twins are (no Lost Boy is allowed to know prophesizes the fate of anything that Peter doesn't). the townspeople. They are therefore enigmas to the children of the corn. http://en.wikipedia.org/wiki/Lost_Boys_(Peter_Pan)

Key Words: Children of the Corn, Stephen King, He Who Walks Behind the Rows, mass murder, harbinger, Joss Whedon, Cabin in the Woods, Wendy Darling, Carl Jung, archetype, Antisocial Personality Disorder, Condut Disorder, Peter Pan, J. M. Barrie, Wendy Darling, Lost Boys, Sigmund Freud, sublimation, Sylvia Davies

Next week’s movie: The Shining (1980)

Movie of the week: The Shining (1980)

Last week’s movie: Children of the Corn (1984)

Synopsis

Jack Torrance, a writer and recovering alcoholic, takes a job as a “winter-over” at the isolated Overlook Hotel. His young son possesses psychic abilities and is able to see things from the past and future, such as the ghosts that haunt the Overlook. The film depicts the trials of the Torrance family, as the abject isolation of the snowbound hotel serves as the setting for the family’s descent into madness, as Jack attempts to murder his wife and son.

The Shining is a film rich in subversive, psychiatric themes, with several interpretations rendered by authors, anthropologists, and historians (Room 237, 2012). This post examines “the true meaning” of Kubrick’s film, and to our knowledge, is the only opinion rendered from a clinical perspective.

How it relates to the field of psychiatry

The Shining serves as an opportunity to teach the Psychotic and Related Disorders. Hallucinations, delusions, disorganized and grossly catatonic behavior, and negative symptoms (affective flattening, apathy, and anhedonia) are all signs possessed by the patriarchal main character. While the general consensus is that The Shining explores themes related to psychosis, Stuart Ullman’s disclosure of the 1970 tragedy of a former caretaker, Grady, “running amok” is foreshadowing of the film’s clandestine meaning. Amok is a culturally (Malaysian) bound syndrome hallmarked by episodes of sudden mass assault following a period of brooding. A brief examination of the film reveals two themes that allow for the formulation of another culturally bound syndrome that explains the behavior of the Torrance family.

A. A pre-established delusion is identified in an individual

Prior to moving into the Overlook, Jack’s son, Danny, has a terrifying premonition about the hotel that causes him to faint. During a medical evaluation, Wendy tells a visiting doctor that her son has an imaginary friend called Tony whose emergence coincides with Danny going to nursery school around the time Jack dislocated his son’s shoulder (following a binge episode).

While the physician reassures Wendy that Danny’s imaginary friend is “just a phase,” there’s reason to believe Tony is a sign of an underlying mental disorder and therefore is not developmentally appropriate. While posttraumatic stress disorder is a provisional diagnosis, two scenes are critical to the formulation of a differential diagnosis. First, Ullman tells Jack that the hotel is built on the site of a 1907 Native American burial ground. Next, a precocious Danny joins the discussion about the Donner party on the way to the Overlook. The ill-fated settlers had to resort to cannibalism after their wagon train was trapped by an early, heavy snowfall through the Sierra Nevada.

Taken together, we can conclude that Danny is afflicted with Wendigo psychosis; a culturally bound syndrome that affects people who think about cannibalism. Originally afflicting individuals of the Algonquin tribe, the syndrome preserves cultural taboos by reinforcing the prohibition against cannibalism. Danny’s taking part in the adult discussion about the Donner party constitutes a significant boundary violation, and results in his becoming possessed by the malevolent cannibalistic spirit.

B. A delusion develops in the context of a close relationship with another person that is similar in content to that of the person who already has the established delusion

Jack wanders into the Gold Room where a ghostly bartender named Lloyd serves him bourbon on the rocks. Meanwhile, Danny’s curiosity gets the better of him when he wanders into Room 237 despite the omen not to enter. When Danny returns from Room 237, he is visibly traumatized, causing Wendy to think that Jack is abusing Danny again. Wendy shows up in the Gold Room and informs Jack that Danny told her a “crazy woman in one of the rooms” was responsible for his injuries.

Jack investigates Room 237 and has an experience similar in content to Danny’s. Specifically, a mysterious female seduces Jack, but then turns into a symbolic manifestation of the wicked woman from Hansel and Gretel (who lured children like Danny with candy before transforming into a witch). The Hansel and Gretel fairy tale was foreshadowed when Wendy first met Dick Hallorann and said she felt the need to put down breadcrumbs in order to find her way around the Overlook. In room 237, we are presented with the Evil Step-Mother Archetype. The universal presence of this motif reinforces that this archetype results from a defense mechanism (splitting) employed by children to contain all they hate in their mothers so they can continue to regard them as perfect (the explanation of why Danny “hates” his mother is beyond the scope of this post).

Upon returning from Room 237, Jack casts an image in the mirror when entering the suite. He tells Wendy he found nothing, explaining that Danny’s bruises were self-inflicted, “I think he did it to himself.” Faced with this reality, Danny becomes acutely psychotic as evidenced by his shining (disorganized or grossly catatonic behavior) into his parents’ conversation. This further establishes that Danny is the proband case of psychosis. This is followed by Jack's exacerbation (transmission) as evidenced by his becoming verbally abusive towards Wendy. As he storms out of the suite, he casts no reflection in the mirror, having truly lost who he is/his soul.

Taken together, The Shining is a case study of Shared Psychotic Disorder (SPD). Also referred to as folie à deux, SPD is a rare psychotic disorder usually found in long-term relationships with close emotional ties.

Table 2. The Evil Step-Mother Archetype1 & The Shining Fairy Tales depicting Theme The Shining (film) Evil Step-Mothers Cinderella Getting home safely before Grady’s runs Amok, and murders midnight his family at the New Year’s Eve gala Hansel and Gretel Cannibalism Donner Pass; “breadcrumb” (1856) reference; Wendigo psychosis Snow White and the Seven Dwarves White, red, The colors of the labyrinth (1819) and black Rapunzel Trapped and Wendy is trapped in the bathroom shut away suite (her hair falling forward) after Danny is let out of the window.

1. The relationship between Danny and his mother has been critically analyzed, and relates to “the twins” who themselves represent Freudian splitting of the mother image.

Key Words: Shining, Overlook, Timberline Lodge, Danny Torrance, Jack Nicholson, Kubrick, cannibalism, Wendigo psychosis, Shared Psychotic Disorder, folie à deux, Stephen King, Hansel and Gretel, Rapunzel

Psycho-nicity: ‘Synchronicity’is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. The Shining and The Thing comprise an annual double feature for the “winter-overs” at the Amundsen-Scott South Pole Station in Antarctica. After watching Kubrick’s film, follow it up with John Carpenter’s The Thing for a similar experience!

Next week’s movie: Psycho (1960)

Movie of the week: Psycho (1960)

Last week’s movie: The Shining (1980)

Synopsis

Marion Crane steals money from work, but her escape is thwarted when a storm forces her to take refuge at the vacant Bates Motel. After the schizoid-like caretaker gives her the key to Cabin 1 (does Psycho deserve consideration for a Top 10 Cabin in the Woods movie?), Norman Bates peeps at his new patron through a hole in the wall of the parlor off the main office. Norman’s voyeuristic deviance is only the beginning of the story, which has its roots in one of the most notorious serial killers in US history. Author Robert Bloch was inspired by Ed Gein to create Norman Bates, the central character of the Alfred Hitchcock's classic thriller, Psycho.

How it relates to the field of psychiatry

The Schizophrenogenic Mother of a Wisconsin Butcher

In 1948, Frieda Fromm-Reichmann’s focus on faulty parental communication as causing Schizophrenia resulted in the theory of the schizophrenogenic mother. Fromm-Reichmann proposed that maladaptive parental traits (see below) significantly influenced the risk of developing Schizophrenia. Although debunked with the dopamine hypothesis and the antecedent discovery of Chlorpromazine, her psychoanalytic theory remains of historical interest.

Edward Theodore Gein was born on August 27, 1906, to Augusta and George Gein in La Crosse, Wisconsin. Augusta was a cold and domineering woman. Her personality traits match Fromm- Reichmann’s description – overprotective, rigid and insensitive, moralistic about sex, rejecting, fearful of intimacy, and conflict-inducing – of the schizophrenogenic mother. Despite never being good enough, Augusta was all that Ed had following the deaths of his father and older brother, Henry. Unfortunately, on December 29th, 1945 (3 years before Fromm-Reichmann’s landmark paper), Augusta died. Ed Gein’s life fell apart after he “lost his only friend and one true love” (Deviant [book] by Harold Schechter)

“A boy’s best friend is his mother” –N. Bates

Like Norman Bates, Ed remained in the house after his mother’s death and developed a morose interest in taxidermy. On November 17, 1957, police in Plainfield, Wisconsin arrived at the old Gein farmhouse. The more they looked through the house, the more human trophies they found, including a suit made entirely of human skin. Norman Bates shared Gein’s passion for taxidermy. However, where Gein was driven by a domineering and conflict-inducing mother, Bates’s motivation was quite different (despite her being described as demanding by the psychiatrist); “Birds are stuffed because they're passive… (and then saying his mother is) as harmless as a bird.” Dissociative Identity Disorder

[Spoiler Alert] When it is discovered that Norma Bates has been “dead and buried in the Greenlawn Cemetery for the past 10 years,” it is revealed that “mother” only exists in Norman’s mind. Like Gein, Norman was predisposed to severe mental illness due to the death of his father and brother. When Norma met a man, Norman’s sense of abandonment resulted in his killing his mother and her new lover. The murders are the precipitant(s) of Norman’s exacerbation. He consequently developed a distinct personality state to erase the crime and protect himself against the guilt of matricide. Psycho is a sensational case study of Dissociative Identity Disorder where Norman’s “alter” (Mother) takes over at the film’s end as we part with the words, “Well she wouldn't even harm a fly.”

Key Words: Psycho, Ed Gein, Augusta Gein, Mother, Wisconsin butcher, Hitchcock, Bates Motel, Norman Bates, taxidermy, Fromm-Reichmann, schizophrenogenic mother, Schizophrenia, Dissociative Identity Disorder, multiple personality disorder

Psycho-nicity: ‘Synchronicity’ is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. A triple feature of Psycho, The Texas Chainsaw Massacre and The Silence of the Lambs may be the most chilling movie series created given that Ed Gein inspired the creation of all 3 films.

Next week’s movie: The Hills Have Eyes (1977)

Movie of the week: The Hills Have Eyes (1977)

Last week’s movie: Psycho (1960)

Synopsis

Based on the life of “Sawney” Bean, The Hills Have Eyes is a 1977 horror film written and directed by Wes Craven depicting the ill-fated fortunes of the Carter family after becoming stranded in the Nevada desert where they are hunted by a cannibalistic clan living in the hills.

At Rutgers Robert Wood Johnson Medical School, we have a module in our Psychopathology course that reviews mental illness through horror movies that are based on real life encounters. Wes Craven’s 1977 film is included among these 10 accounts.

How it relates to the field of psychiatry

The conflict between the Carter family and the Cannibalistic Hill-Usurping Desert (CHUD) mutants parallels The Titanomachy; the 10-year war between the gods of Olympus and the titans.

After the mighty titan, Saturn, took his father’s (Uranus) throne in fulfillment of an ancient prophesy, he secured his power by re-imprisoning his siblings (the Hecatonchires and Cyclopes) in Tartarus.

In The Hills Have Eyes, a similar “legend” is told by Fred when he relates the story of his son, Papa Jupiter, who raised a family of deranged cannibals who dwell in the desert. Fred, who symbolizes Saturn, left his son in the hills to die. Similar to Jupiter (Zeus) surviving the murder attempt by his father (Saturn) and surviving in a Cretan cave, Papa Jupiter also survived. Papa Jupiter had 3 sons named Mars, Pluto, and Mercury, the same names given to Jupiter’s (Zeus) sons brother.

The myth of The Titanomachy served to give a culture the answer to the origin of the universe. This universal question is central to existentialism; “man’s search for meaning.” Just as the Carter family searches for a way out of the desert (their personal existential hell), so too do all individuals search for the existential meaning of life.

Table 3. Parallels Between Roman Mythology & Wes Craven’s The Hills Have Eyes Roman Mythology The Hills Have Eyes (gods, titans & heros) Saturn, paranoid and fearing the end of his rule, Pluto abducts the Carter’s baby (Katie), who the “titans swallowed each of his children whole as they were of the hills” plan to feast on for Thanksgiving. born. Rhea managed to hide her youngest child, Jupiter, by Ruby knocks out Mama and escapes with Katie into the tricking Saturn into swallowing a rock wrapped in hills, where she is pursued by Mars. swaddling clothes. After Jupiter and the other Olympians won, the Titans were imprisoned in Tartarus Ixion is punished in Hades, bound by Zeus to a wheel Papa Jupiter is killed by a snare trap set by Brenda and that is perpetually spun. Bobby using a spinning wheel of a car. Prometheus is cursed to spend eternity bound to a Mercury is pushed off a hilltop by Beast, falling to his hilltop and have his liver devoured by a beast each day death. (only to have it grow back every night). Achilles is killed during the Trojan War when he’s Beast tears Pluto’s throat out after incapacitating him mortally wounded by an arrow shot by Paris. by biting his Achilles tendon. Hera sent two snakes to kill Heracles in his crib, but When Mars tries to kill Doug, Ruby puts a rattlesnake Heracles strangled a snake in each hand and played on his neck, enabling Doug to overpower him. with the dead bodies as though they were toys.

Key Words: The Hills Have Eyes, mutants, Wes Craven, cannibalism, Olympians, Roman gods, mythology, The Titanomachy, Saturn, Uranus, Hecatonchires, Cyclopes, existentialism, Man’s Search for Meaning

Psycho-nicity: ‘Synchronicity’ is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. For a truly unique experience, watch The Hills Have Eyes, read biographical information on Alexander “Sawney” Bean, then re-watch the movie and appreciate that it’s even more horrifying.

Next week’s movie: Terror at Tenkiller (1986)

Movie of the week: Terror at Tenkiller (1986)

Last week’s movie: The Hills Have Eyes (1977)

Synopsis

Stuck in an abusive relationship, Leslie is convinced by Janna to join her on a weekend escape to her cabin in the woods. Following the sign for Gore, Oklahoma, the women take the first left to Lake Tenkiller harbor, the setting for this 1986 horror movie, and the 21st destination of our year-long virtual road trip.

The lake is named for an urban legend of a brave Native American squaw who avenged her sister’s death by killing 10 of the bravest warriors of the enemy tribe. She was killed along with the last warrior, but her spirit lives at the bottom of Lake Tenkiller and protects women like Leslie from men like (her boyfriend) Josh.

How it relates to the field of psychiatry

For centuries, woods have marked the edges of humanity’s domain. Across Europe, North America and the Far East, we have carved living space out of the woods; as such, woods are the realm of the psyche and a place of unknown danger and cultural taboos.

Entering the Dark Wood or the Enchanted Forest is a threshold symbol; the soul entering the perils of the unknown (J.C. Cooper, An Illustrated Encyclopaedia of Traditional Symbols). As such, movies such as Terror at Tenkiller examine our existential search for meaning. During the journey, one may encounter a wolf in sheep’s clothing, a zombie redneck torture family, or Tor; all externalized manifestations of our unconscious prohibitions that must be overcome in order to achieve self-actualization. The woods also serve as the primordial stew for the archetypes such as the Mother (grandma, Little Red Riding Hood), the Witch (Hansel and Gretel), the Trickster (Tor), and the Hero (Tenkiller).

Key Words: Terror at Tenkiller, cabin in the woods, Joss Whedon, J.C. Cooper, Little Red Riding Hood, Hansel and Gretel, Jung, archetypes

Psycho-nicity: ‘Synchronicity’ is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. While Terror at Tenkiller falls short of our Top 5 list, the transcendental experience would be to rent a cabin (in the woods), and watch 5 movies with a cabin in the woods including those on January 2, February 13, and March 13 on our itinerary.

Next week’s movie: The Town that Dreaded Sundown (1976) Movie of the week: The Town that Dreaded Sundown (1976)

Last week’s movie: Terror at Tenkiller (1986)

Synopsis

As we enter the “Natural State,” we find ourselves at the midpoint of our year-long academic journey: 52in52. This week (although the narrator sets the film on Sunday, March 3), we are introduced to the townspeople of Texarkana, a border town on the Red River in Miller County, AR. The people of Texarkana are getting back to normal life following World War 2 when the town becomes paralyzed by a series of murders loosely based on the “Phantom Killer” murders that took place between February 22, 1946 and May 3, 1946.

The Town that Dreaded Sundown is one of the seminal films of the slasher genre, premiering 2 years before Arthur Miller’s Halloween.

How it relates to the field of psychiatry

The Town that Dreaded Sundown depicts murders occurring in lovers’ lanes, and therefore shares the moral of such stories as the urban legend, The Hook Man, a cautionary tale about the potential consequences of premarital sex first published in a Dear Abby column in 1960. The fact that the murders take place every 21 days may also have symbolic meaning. Among other things, 21 is the number of destruction (French philosopher, Louis Claude de Saint-Martin). Since the film is narrated, it is reasonable to assume that despite its being loosely based on the non- fictional Phantom murders, the events we see are a story told by “the elders” of Texarkana during a period of transition to ensure their small town values will be preserved.

What’s in a Title?

While urban legends aim to teach lessons according to operant conditioning principles, the “dread” in The Town that Dreaded Sundown results from learned behavior that is part of a classical conditioning paradigm. In this case, the murders (UCS) result in dread (UCR). When the murders (UCS) are paired with sundown (CS), the townspeople become fearful (CR) of sundown (CS), itself.

A remake of the movie depicts a copycat killer who preys on patrons at the annual showing of the film at Spring Lake Park, TX. Similar themes can be found in films portraying The Hook Man including Candyman (1992) and I Know What You Did Last Summer (1997).

Key words: The Town that Dreaded Sundown, Phantom, Youell Lee Swinney, lovers’ lane, slasher, urban legend, Hook Man, classical conditioning, Pavlov, Spring Lake Park, Candyman, I Know What You Did Last Summer. Psycho-nicity: Synchronicity‟ is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. The Town that Dreaded Sundown is another movie inspired by real life events, and therefore is best viewed as part of a series that includes movies like the one we visited on December 5. If you are ever in the Dallas-Fort Worth area in October, take a 2-hour trip to Spring Lake Park, TX for “Movies in the Park” where The Town that Dreaded Sundown is the annual headliner.

Next week’s movie: The Evil Dead (1981)

Movie of the week: The Evil Dead (1981)

Last week’s movie: The Town that Dreaded Sundown (1976)

Synopsis

Given its cult status, this week‟s blog will be on Evil Dead 2: Dead by Dawn (1987), a parody sequel to Sam Rami’s 1981 film that begins with a revised recap of the events of the first movie. The background provided introduces the Necronomicon Ex-Mortis (Book of the Dead). Similar to the Lemarchand configuration (Hellraiser, 1987), the Book of the Dead serves as a passage way to an evil dimension.

Having disappeared in 1300 AD, Professor Knowby discovers the book in the rear chamber of the Castle of Cantar. The film depicts the events of a group upon discovering Knowby‟s tapes; translations that have resurrected a spiritual presence (deadites) that can possess the living.

How it relates to the field of psychiatry

Evil Dead 2: Dead by Dawn serves as an opportunity to teach the Dissociative Disorders. After Linda is possessed by the deadites, Ash decapitates his girlfriend and buries her in a shallow grave. While defense mechanisms such as denial and projection (anger) are characteristically associated with bereavement, Ash demonstrates another defense, dissociation. He is grieving while holding Linda‟s charm when sees the piano play itself. The piano being experienced as unreal and dreamlike is defining of derealization (defining of Depersonalization/Derealization Disorder, a type of Dissociative Disorder).

What follows is one of the most iconic scenes in horror film history, and one that serves to reinforce the Dissociative Disorders. Ash’s derealization continues when he reaches out to touch a chair rocking by itself. He then experiences detachment with respect to his body (hand). During his depersonalization, his “alien hand” smashes dishes and punches himself, rendering him unconscious. This particular form of Depersonalization/Derealization Disorder is sometimes referred to as the Alien Hand Syndrome.

Linda, and later, (Bad) Ash, have a disruption of identify that is experienced as possession. As such, they meet criteria for Dissociative Identity Disorder (we’ll delve into this more deeply on March 6 when we examine Peter Blatty‟s The Exorcist).

Finally, the movie also follows Jungian psychology and the hero archetype; the hero from the sky (Good Ash) who is prophesized to destroy the ancient evil.

Table 4. Clues to the Manipulated Evil Dead: A summary of characters killed by deadites in Evil Dead 2

Character Location Weapon

Linda in the woods with the shovel

Bobby Jo in the woods with the angry molesting tree

Jake in the cabin with the deadites (Henrietta)

Annie in the cabin with the dagger

Key words: Evil Dead, Dead by Dawn, angry molesting tree, deadites, Necronomicon Ex- Mortis, Book of the Dead, dissociation, Dissociative Disorders, derealization, depersonalization, Jung, hero archetype, Donnie Darko, The Philosophy of Time Travel

Psycho-nicity: “Synchronicity” is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience.

Evil Dead 2: Dead by Dawn parallels other movies depicting the hero archetype including Donnie Darko (2001). Darko, a movie about a first-break psychosis, introduces The Philosophy of Time Travel; a manuscript “to be used as a simple and direct guide in a time of great danger” (universe to implode). The guide defines the necessary elements and “players” for time travel such as the “manipulated dead” (Table 4).

The above table draws a parallel (pun intended) with the Evil Dead 2, a film that eerily follows The Philosophy of Time Travel, as Ash (living receiver) battles the evil (manipulatd) dead, after reciting passages from the Necronomicon Ex-Mortis (artifact).

For a truly unique movie experience; a) watch Donnie Darko, b) read The Philosophy of Time Travel, c) re-watch Donnie Darko, then d) make it a double feature by watching Evil Dead 2: Dead by Dawn.

Next week’s movie: The Return of the Living Dead (1985)

Movie of the week: The Return of the Living Dead (1985)

Last week’s movie: The Evil Dead (1981)

Synopsis

The most successful zombie comedy of the decade, The Return of the Living Dead is a horror film about three men and a group of teenagers who battle a horde of brain-eating zombies. The cause of the outbreak is traced back to a 1969 chemical spill at a VA hospital in Pittsburgh, Pa.

The film is acclaimed for giving the zombie its voice and appetite for human brains. It is also noted to be the first film where destroying the brain doesn’t stop the zombie (Jovanka Vuckovic, Zombies!: An Illustrated History of the Undead).

How it relates to the field of psychiatry

With the production of The Earth Dies Screaming (1965), followed by George A. Romero’s Night of the Living Dead 3 years later, the zombie has long served as a milieu for primordial human dynamics. In The Return of the Living Dead (Return), we witness the depths human nature can explore as exemplified by Burt’s abandoning Ernie and Tina despite Spider’s pleas to go back for them. Beyond the “we have met the enemy and he is us” motif, Return is renowned for several breakthroughs in the zombie genre, each of which serves a metaphorical teaching point in psychiatry.

Appetite for human brains

While it would be blatantly irresponsible to refer to individuals afflicted with Major Depressive Disorder (MDD) as “zombies” or “monsters,” the zombie can be referenced to identify features consistent with MDD (similarly, for pedagogic purposes, a skeleton can be used to teach metastatic disease in a case of cancer cachexia). As such, an alteration (decrease or increase) in appetite that represents a change from previous functioning is defining of MDD. Not only do zombies in general manifest a change (e.g. increase) in appetite, but Return is credited for changing the genre’s appetite to one that craves human brains.

If the zombie serves as a metaphor of MDD for pedagogic purposes, then those depicted in Return would be afflicted with a Substance-Induced Depressive Disorder (SIDD). Specifically, their change in appetite is attributable to the physiologic effects of a substance (toxic gas).

Zombies are resistant to their brains being destroyed

Since Revenge of the Zombies (1943), it’s been widely held that you can stop a zombie by affecting its brain. In 1952, upon learning of the stimulating side effects of the anti-tuberculosis drug, isoniazid, Max Lurie used it to treat his psychiatric patients and later coined the term “antidepressant.” From the discovery of the first antidepressant, the catecholamine hypothesis has been central to the treatment of MDD. By affecting the brain and correcting the “chemical imbalance,” antidepressants remain among the most widely prescribed drugs in the US. However, their efficacy is relatively poor when the alteration of mood is due to a SIDD. Ironically, as Return serves as a metaphor for a case study of SIDD, we shouldn’t be surprised that it’s the first movie where affecting the brain doesn’t “cure the zombie.”

Key words: Return of the Living Dead, zombies, Jovanka Vuckovic, Major Depressive Disorder, Substance-Induced Mood Disorder, Substance-Induced Depressive Disorder, Revenge of the Zombies, Night of the Living Dead, tuberculosis, isoniazid, antidepressant, catecholamine hypothesis

Next week’s movie: An American Crime (2007)

Movie of the week: An American Crime (2007)

Last week’s movie: The Return of the Living Dead (1985)

Synopsis

An American Crime is a drama based on the true story of Sylvia Likens told through a series of flashbacks of eye witnesses during 1966 trial of Gertrude Baniszewski.

The movie accounts the life of sisters, Sylvia and Jenny Likens after their father leaves them in the custody of Gertrude so that he can travel with the carnival through Indiana. The carnival has long been the setting for folkloric myths intertwined with mental illness. From the human novelty exhibition of Joseph Merrick (the Elephant Man) to Erik from Gaston Leroux’s 1910 novel The Phantom of the Opera, both man and mystery are “one combined.” However, the carnival has never been as unsettling of a backdrop as the one it provides for An American Crime.

How it relates to the field of psychiatry

We are first introduced to Gertrude (Gerti) Nadine Baniszewski upon her returning from a place of worship when she tells a fellow parishioner that she “is better,” and that now, she can pick-up more ironing as she tries to make ends meet. While the conversation on the bus establishes a history of mental illness, we are not provided any further details.

In addition to psychiatric themes such as Nicotine Use Disorder, and possibly Pedophilic Disorder, the focus of the film is Gerti’s disorganized behavior (impulsively whipping Sylvia when payment is late) which is initially observed upon adopting the responsibility of Sylvia and Jenny Likens. Despite Mr. Likens’s $20 coming soon after, Gerti’s violent behavior continues and progresses to torture. Further evidence of her denial occurs when she confronts Sylvia, “you flirt with Andy…I saw you!” What was a neutral interaction between Sylvia and Gerti’s ex- boyfriend was imparted a fixed belief shrouded in jealousy. While Gerti demonstrates psychotic symptoms as described above, she likely does not have a primary psychotic disorder given that she appears cognitively intact. As a formal thought disorder, we would have expected Gerti to demonstrate deficits in attention, memory or speech if she was afflicted with a psychotic illness such as Schizophrenia.

Later, Gerti discloses that she’s addicted to Phenobarbital and Chlorpheniramine (an antihistamine). Taken together, Gerti’s chronic cough is likely due to asthma (and possible gastroesophageal reflux disease, GERD), both of which are worsened by cigarette smoking. Her self-medicating with the above drugs exacerbated psychotic and antisocial traits that directly contributed to the torture, rape, and death of Sylvia Likens. Given that Coricidin contains acetaminophen in addition to chlorpheniramine, liver toxicity (rule-out encephalopathy) may have further contributed to Gerti’s behavior.

The film may also be viewed through the eyes of the other children, who choose not to intervene when Sylvia is repeatedly tortured. Here, 2 characters deserve special mention; Johnny and Ricky. Johnny demonstrates cruelty to animals and a motivated disregard for others’ safety. Given his age, 13, he is therefore likely afflicted with Conduct Disorder. Conversely, Ricky’s behavior is likely the result of the Stockholm syndrome; stress resulting in his loss of identity and consequent identification with the aggressors.

Finally, the film itself appears to be an artistic expression of the double bind, a family dynamic where a person receives simultaneous mixed messages. For example, a child receives two conflicting messages about their relationship when a mother tells her son that she loves him, while at the same time turning her head away in disgust. In An American Crime, the disturbing content is balanced by the equal and opposite music from a soundtrack that includes Petula Clark’s Downtown and Lesley Gore’s You Don’t Own Me.

Key Words: An American Crime, Gertrude Baniszewski, Sylvia Likens, The Girl Next Door, torture, Coricidin, Conduct Disorder, Stockholm syndrome, double bind, Gregory Bateson

Next week’s movie: A Nightmare on Elm Street (1984)

Movie of the week: A Nightmare on Elm Street (1984)

Last week’s movie: An American Crime (2007)

Synopsis

A Nightmare on Elm Street is a slasher film set in the fictional town of Springwood, Ohio. The plot revolves around Alice and her teenage friends who are stalked and killed in their dreams by the omnipresent, blade-gloved Freddy Krueger. The reason behind Freddie’s rampage lies in the parent’s sinister secret from years ago.

The greatness of Craven’s film is the identification with the characters doesn’t end with the movie’s finale. Instead, it continues following the movie. As anyone whose had a nightmare after watching this film will attest, it’s the moment after you wake up from the terrifying dream that is potentially horrifying, as it is then that you’re put in the exact same position as the main characters.

How it relates to the field of psychiatry

As the title implies, A Nightmare on Elm Street (Nightmare) depicts Nightmare Disorder (ND); repeated awakenings with recollection of terrifying dreams, usually involving threats to survival such as being hunted by a child murderer. Upon awakening from her nightmares, Alice is alert and able to recall the dream in detail. These details differentiate ND from Sleep Terror Disorder. With sleep terrors, there is no detailed recall of the dream. While the above sleep disorders (parasomnias) are in the differential diagnosis for what ails the teenagers in the film, so too is a dyssomnia.

Dyssomnias are disturbances in the quality, amount, or timing of sleep. While a discussion of sleep stages is beyond the scope of this article, the movie is about a recurrent nightmare (REM sleep) that invades the teenagers’ wakeful states. In this way, Nightmare is a metaphor for a dyssomnia defined by REM invasion into the beta state (wakefulness), specifically, Narcolepsy. Narcolepsy usually has its onset in adolescence (e.g. Alice), is characterized by hallucinations (seeing the boogeyman), and is genetically predisposed. Metaphorically, Alice and her friends carry the (genetic) burden of their parents.

While it is established that Freddie Krueger was a child murderer, the backstory is that he’s afflicted with Pedophilic Disorder. His having a paraphilia provides depth to Nancy’s character. Tina, Glen, and Rod are all murdered in bed, the location being symbolic of Freddie’s sexual disorder. While the history of Freddie as a child murderer is ultimately provided by her mother, Nancy’s discovery is metaphorical of the discovery of her lost memories. When Freddie is pursuing her, she runs to the basement of her home which looks distorted, a product of derealization likely due to anxiety. One focus of Nightmare is the distinction between dreams and reality. Given the film’s ability to transgress “the boundaries between the imaginary and real,” Nancy’s experience in the basement may be a nightmare (sleep) or a flashback (wakefulness) that is cued by the situation. Specifically, she was likely imprisoned in Freddie’s boiler room (basement). Unlike the other characters, Nancy is “kept alive” by Freddie, and slowly learns the truth about her nightmares. Freddie considered her special in some respect. Nancy’s mother, Marge, kept Freddie’s hat and glove; bizarre behavior if Freddie was “just a child murderer.” Years prior, Marge likely had an affair with Fred Krueger (which would be consistent with her having separated from her husband in present day), but had a blind eye to her boyfriend’s conduct towards her daughter. Alice and her friends are victims of the sins of their parents.

Nightmare then is not merely about Sleep and Awake Disorders such as Nightmare Disorder or Narcolepsy. Alice’s sleep pathology is likely due to Posttraumatic Stress Disorder, having been a victim of childhood sexual abuse.

Key Words: A Nightmare on Elm Street, Nightmare Disorder, REM, Sleep Terror Disorder, Narcolepsy, Pedophilic Disorder, Freddie Krueger, slasher, Posttraumatic Stress Disorder, PTSD, dyssomnia, parasomnia

Next week’s movie: Wrong Turn (2003)

Movie of the week: Wrong Turn (2003)

Last week’s movie: A Nightmare on Elm Street (1984)

Synopsis

Inspired by our December 12 trek through New Mexico, The Hills Have Eyes, Wrong Turn is a horror movie depicting medical student, Chris Flynn, and his unfortunate rendezvous with five motorists stranded in the West Virginia “holler.” Just when you might be tempted to argue that Silent Hill (2006) is a more deserving horror movie in West Virginia, we are made aware of the role of the main character. Since the medical student has WV license plates, he most likely attends West Virginia University. Any horror movie depicting a WVU medical student warrants top billing in 52in52 (with all due respect to Silent Hill)!

While it’s near impossible to mention ‘West Virginia’ and ‘medical student’ in the same sentence without thinking about Morgantown (or Charleston), it’s the film’s rural setting that allows for a sinister, if not prejudicial, backdrop for horror, with the archetypal, prosocial warning to “be careful taking the path less beaten.” Scott even references Deliverance (1972) despite that film being set in Georgia (he would have done well to check out April 3 on our 52in52 itinerary). While the history of the cannibalistic, half-feral, mutants is disclosed in subsequent sequels, the following post is based solely on the original film.

How it relates to the field of psychiatry

Wrong Turn serves to review the algorithm on how to diagnostically approach mental illness. The 3-step process includes ensuring that a patient’s chief complaint is not due to a) another general medical condition or b) the direct physiologic effects of a substance. The DSM-5 lists potential substances as medications, drugs, or toxins. Only after these are ruled-out should a psychiatrist c) attribute the patient’s symptoms to mental illness.

A. Rule-out Another Medical Disorder

As early as the opening credits, we are reminded of the effects genetics play in the predisposition of mental illness. Signs and symptoms such as “psychosis” and violent outbursts” appear in a montage of newspaper articles along with hints genetic predisposition.

B. Rule-out the Direct Physiologic Effects of a Substance

Immediately following the opening credits, we see Chris Flynn driving to Raleigh. The music on the car radio references whiskey, and serves as foreshadowing to alcohol’s influence on the plot. When his route is blocked by a chemical (toxin) spill, viewers are left to wonder if the highway is a corridor for the transport of hazardous materials and if so, whether exposure to previous spills are the cause of the mutants’ pathology. In this sense, Wrong Turn may be viewed as a rhetorical case study of a substance- or toxin-induced psychotic disorder. Soon after he crashes into the hikers’ truck, they refer to Fran and Evan as “stoners,” and Jessie calls Chris a “mule.”

C. Mental Illness

Once A and B above have been ruled-out, psychiatrists will begin to formulate the most likely diagnosis based on current, recent, and past signs and symptoms. Since it’s established that the prominent symptoms are psychotic, our most likely and differential diagnoses will come from the Schizophrenia and Related Disorders chapter.

Since Wrong Turn is likely a case study of a toxin-induced psychotic disorder (choice B above), elaboration on a primary psychotic disorder is beyond the scope of this post. Interestingly, alcohol use also figured prominently in many adaptations of the blood feud between the West Virginia family, the Hatfields, and their Kentucky rivals (McCoys). Wrong Turn then is another cautionary tale in West Virginia folklore about the hazards of excessive alcohol use.

Table 5. Characters from Wrong Turn fitting into Joss Whedon’s Archetypes Cabin in the Woods archetype Character from Wrong Turn

The Slut Francine

The Athlete Jessie Burlingame

The Scholar Chris Flynn

The Fool Evan

The Virgins Scott and Carly (we had to improvise)

Key Words: West Virginia, holler, cannibalism, Deliverance, substance-induced psychotic disorder, Hatfields and McCoys, alcoholism, Joss Whedon, Cabin in the Woods

Next Week’s Movie: Night of the Living Dead (1968)

Movie of the week: Night of the Living Dead (1968)

Last week’s movie: Wrong Turn (2013)

Synopsis

Night of the Living Dead is an independent film directed by George A. Romero that follows a wayward protagonist, Ben, and 6 others who are trapped in a rural Pennsylvania farmhouse. Their shelter is attacked by “living dead” ghouls, making Night the landmark zombie film of its generation. Among Night’s many contributions are that the zombies a) resemble “regular people,” b) possess memory and rudimentary intelligence, c) could be de-animated only by destroying the brain, and d) are cannibals.

How it relates to the field of psychiatry

Night of the Living Dead is renowned for relegating the zombie horde to a backdrop of the human condition, thus allowing the viewer to focus on human motivation during a time of crisis. In his 1943 manuscript, “A Theory of Human Motivation,” Abraham Maslow posited a hierarchy of human needs based on two groupings: deficiency needs and growth needs. Night of the Living Dead serves to review Maslow’s deficiency needs; specifically, those of physiological, safety, belongingness, and esteem.

Within the deficiency needs, each lower need must be met before moving to the next level. This principle is tested with the introduction of Mr. Harry Cooper and Tom, as the group dynamic displaces the zombie as the primary threat. Harry represents the need for safety/shelter, as he is adamant that the cellar is the most secure area of the home. His point of view is opposed by Ben who counters that the upstairs is the most important area to protect because of its resources (including the physiological need for food). Thus, their conflict of prioritizing their deficiency needs replaces the zombies as the primary threat. Ben’s assertion is loyal to the Maslowian pyramid, as Harry puts safety needs ahead of the biological. Their conflict reaches a pinnacle when Harry grabs Ben’s rifle and threatens to shoot him. [Spoiler Alert] Ben wrestles the gun away when it fires, mortally wounding Harry who (ironically) stumbles into the cellar and dies.

Key Words: Night of the Living Dead, zombie, Romero, Maslow, human motivation, Return of the Living Dead, cannibal

Next week’s movie: Friday the 13th (1980)

Movie of the week: Friday the 13th (1980)

Last week’s movie: Night of the Living Dead (1968)

Synopsis

Filmed in Blairstown, NJ, Friday the 13th is a 1980 slasher film written by Victor Miller. New Jersey stands second to no one when it comes to the weird and sinister. Many movies (The Toxic Avenger) and media (War of the Worlds radio broadcast) have either been set in or inspired by (Jaws, Halloween) events that have occurred in the Great Garden State (yes, even The Amityville Horror was partially filmed in Toms River, NJ!).

Friday the 13th depicts a group of teenagers who are murdered one-by-one while attempting to reopen an abandoned campsite. The movie begins in the summer of 1957 with two camp counselors being murdered by an unseen assailant after they sneak away to a cabin to “party.” The film then jumps to present day, and chronicles the ill-fated attempt of Steve Christy and a group of counselors to reopen Camp Crystal Lake. Friday the 13th introduces the über-slasher, Jason Voorhees, an imposing giant donning a goalie mask and wielding a machete.

How it relates to the field of psychiatry

The Substance Related and Addictive Disorders chapter in the DSM-5 includes the category of Substance-Induced Disorders. Substance-Induced Disorders may include substance intoxication, substance withdrawal, substance-induced mental disorders (e.g. Alcohol-Induced Mood Disorder) and other syndromes caused by the ingestion of a substance (e.g. fetal alcohol syndrome, overdose, etc.).

Friday the 13th serves to teach points of the Substance-Induced Disorders and Syndromes such as the introduction of the fetal alcohol syndrome (FAS) through plot summary. For example, the motive behind the mass murders at Camp Crystal Lake correlates with a case of FAS. [Spoiler Alert] When Mrs. Voorhees reveals herself as the killer, we learn that her rampage is the result of severe mental illness endured from the loss of her son, Jason, who drowned because camp counselors were drinking and having sex instead of supervising the young boy. Just as FAS results from the teratogenic effects of alcohol (in utero), the fate of a young Jason Voorhees resulted directly from the influence of alcohol on camp counselors who were partying instead of supervising the 11-year-old boy swimming in Crystal Lake.

Key Words: New Jersey, Garden State, War of the Worlds, Jaws, Halloween, The Amityville Horror, The Toxic Avenger, Friday the 13th, Jason Voorhees, Camp Crystal Lake, slasher, Substance Related and Addictive Disorders, Substance-Induced Disorders, Fetal Alcohol Syndrome, FAS

Next week’s movie: I Can See You (2008) Movie of the week: I Can See You (2008)

Last week’s movie: Friday the 13th (1980)

Synopsis

The United States of Horror Films map earmarked Carnival of the Dead for this week’s destination movie. Unfortunately, efforts at Rutgers Robert Wood Johnson Medical School to find the film were unsuccessful. Alternatively, we arbitrarily chose I Can See You as the film to represent the First State. The 2008 horror film depicts a camping trip of Ben Richards, Doug Quaid, John Kimble, and Sonia Roja; advertising workers who are seeking inspiration for an ad campaign. When a camper mysteriously disappears, reality testing breaks down, and everyone’s safety is put in imminent jeopardy.

How it relates to the field of psychiatry

On the way to the campsite, Kimble receives a phone call from Ivan, who invites the group to a barbecue. When they arrive, Richards sees Summer Day, a former crush, who Richards refers to as a hippie. As the two rekindle their relationship, the pictures Richards takes of the wilderness come out distorted and parallel his difficulty focusing his vision (accommodation). When he goes swimming in a stream with Summer, Richards removes his glasses, and has as much difficulty with his speech as with his sight. Summer leaves, but with his vision blurred, Richards doesn’t see where she goes. Having been the last one to talk with Summer before she went missing, Quaid is sought by Richards and Kimble when they uncover his camera (and see pictures he took of Summer). They find him disoriented, and after Quaid runs off, Richards discovers his body at the bottom of a cliff. Richards then hallucinates when he see Hauser who tells him to take a second look at the cliff without his glasses (Richards then throws his glasses over the edge).

Summer’s background, the pervasive theme of having difficulty with accommodation, jumping from a cliff (believing he can fly?), and hallucinations all point to LSD intoxication as the source of the campers’ horror. Additionally, the plot may also incorporate Dimethoxybromoamphetamine (DOB) as an adulterant. Also known as brolamfetamine and bromo-DMA, DOB is similar to 3,4-methylenedioxy-methamphetamine (MDMA), a substituted amphetamine that has a different dose response curve than LSD. Specifically, DOB takes up to 6 hours to take full effect. Consequently, unsuspecting users, such as the campers, who believe they are taking LSD may re-dose after 3 hours (and accidentally overdose). While not “clinically significant” in the film, DOB’s onset of action increases when used in conjunction with alcohol, which the campers drink throughout the movie.

With LSD and MDMA currently undergoing clinical trials for substance-related and anxiety disorders, perhaps I Can See You is really about a group of advertising workers from a pharmaceutical company whose psychedelic product is in a Phase 1 trial. Specifically, Ben and his peers form the small (treatment) group necessary to evaluate safety, determine safe dosage ranges, and identify side effects of their new project. It would be interesting to see if the sequel depicts a larger group of people (Phase 2 trials are larger) with weirder experiences (larger treatment groups reveal less common side effects). This would also allow for the universality of the group experience in I Can See You to evolve into depictions of the characters’ (subjects) own personal hell.

Key Words: Delaware, I Can See You, Lysergic Acid Diethylamide (LSD), DOB, bromo-DMA, 3,4-methylenedioxy-methamphetamine, MDMA, ecstasy, molly, adulterant, cutting a drug, dosing a drug, psychedelic, Alice in Wonderland, white rabbit, clinical trial

Next week’s movie: The Blair Witch Project (1999)

Movie of the week: The Blair Witch Project (1999)

Last week’s movie: I Can See You (2008)

Synopsis

The Blair Witch Project is a “found footage” docudrama about 3 student filmmakers who investigate the Legend of the Blair Witch. The urban legend tells of the 1940’s deaths of numerous children in Blair (present day Burkittsville), Maryland. In true Stephen King fashion, the small town values are a façade over Burkittsville’s sinister secret; the mystery of an “old hermit” who lives in a cabin in the woods who is somehow tied to “an old woman whose feet never touched the ground” (a.k.a. the Blair Witch). The Blair Witch Project is about 2 intertwining legends, and therefore may be depicted as “The Sandman meets Home Alone.”

How it relates to the field of psychiatry

Like all urban legends, the Legend of the Blair Witch reinforces a taboo so that a culture can maintain social order. The legend likely reinforces the prosocial value of “early to bed, early to rise.” As an interview with a “townie” in the beginning of the film discloses; if you try to stay up late, the Blair Witch will get you. There are parallels with this legend and similar prosocial warnings of the Sandman (sleep with one eye open, holding your pillow tight) and Santa Clause. While the latter promises gifts if you go to bed early (positive reinforcement), the Sandman sanctions (positive) punishment to little boys and girls who get up once they’re tucked in.

On their second day, the hikers locate an old cemetery with seven small cairns. The rock formations are metaphors for their having found the “old hermit.” Translations of the term “cairn” include “stone man” (German steinmann), “imitation of a person” (Inuit inuksuk), and “small man” (Italian ometto). Their discovery is that of the “small man,” Mr. Parr, an old hermit and outcast likely afflicted with Schizoid Personality Disorder. Characterized by social inhibition, the detachment from meaningful relationships usually leads to the afflicted being deemed a loner. It’s often human nature to impart meaning to people who don’t otherwise share who they are. Individuals with Schizoid Personality Disorder then may become the focus of town folklore such as a man who moves into the Black Hills to avoid human contact (also, Kid Lester in The Best of Times; Old Man Marley in Home Alone; and the Witch in Big Fish).

Key Words: Maryland, Blair Witch Project, found footage, Stephen King, sandman, Santa Clause, reinforcement, punishment, operant conditioning, hermit, Schizoid Personality Disorder, cabin in the woods, Joss Whedon, The Best of Times, Home Alone, Big Fish

Next week’s movie: The Exorcist (1973)

Movie of the week: The Exorcist (1973)

Last week’s movie: The Blair Witch Project (1999)

Synopsis

The seminal movie of the ‘demonic possession’ subgenre is William Friedkin’s 1973 film adaptation of The Exorcist. Like our trip through Connecticut (The Conjuring) in Week 5, the film and its novel are based on true events. In a 1972 New York Times article titled “Everyone’s Reading It, Billy’s Filming It,” Chris Chase reported that Peter Blatty based his novel on the 1949 Washington Post story, “Priest Frees Mt. Rainier Boy Reported Held in Devil’s Grip.” Details are provided in the personal diary of Fr. Raymond Bishop who performed over 30 exorcisms on 13-year-old Roland Doe. Supernatural occurrences noted in the diary included, but were not limited to, distortions in Doe’s voice (1). It has been speculated that Doe’s behavior may have been the result of a Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal (PANDAS) infection.

How it relates to the field of psychiatry

At Rutgers Robert Wood Johnson Medical School, the first module – titled Necromancy – of our year-long resident Psychopathology course focuses on ghosts (wraiths) and demons. While the former references disorders that are episodic in nature, tales of demonic possession serve to reinforce teaching points of chronic and persistent illnesses such as the Dissociative Disorders (DD). At the completion of the DD block, participants should appreciate that movies about demonic possession may be metaphorically interpreted as case studies of dissociation. For example, the hallmark characteristic of Dissociative Identity Disorder, a disruption of identity, may be described in some cultures as an experience of possession (DSM-5).

Another pedagogic lesson of The Exorcist references Holotropic Breathwork (HB). HB combines music with accelerated breathing to reach an “altered state of consciousness” as a form of self- exploration and psychotherapy. In their book (2), the Grofs describe the experience of demonic energy as “a change in facial and vocal expression…their voice is deep and raspy…spastic contractions make their hands look like claws, and their entire body tenses. [They] can muster physical strength.” After an outburst, everything quiets down and there is an eerie silence.

Regan demonstrates the pathognomonic description of demonic energy, which is associated with reliving memories of severe childhood trauma. The absence of her father and nocturnal enuresis (urinates coming down the stairs) lend further support to this potential etiology of Regan’s “possession.” Key Words: Washington, William Friedkin, Peter Blatty, The Exorcist, Dissociative Identity Disorder, Fr. Raymond Bishop, Ronald Doe, PANDAS, Grof, Holotropic Breathwork, demonic energy

References

1. http://www.huffingtonpost.com/2013/10/23/horror-films-inspired-by-real- life_n_4150442.html

2. Grof S, MD & Grof C, PhDhc. Holotropic Breathwork, p 194-95.

Next Week’s Movie: Mama (2013)

Movie of the week: Mama (2013)

Last week’s movie: The Exorcist (1973)

Synopsis

Mama is a supernatural horror movie by Andrés Muschietti that is based on his 2008 Argentine short film Mamá about two feral children abandoned in a cabin in the woods who are fostered by a ghost that they affectionately call “Mama.” Victoria and Lilly are abandoned in Helvetia (the name of the cabin) by their father after his attempted murder-suicide is thwarted by the cabin’s supernatural resident. The film depicts the plight of the children upon being discovered, as their new family must battle Mama when it follows the children to their new home.

How it relates to the field of psychiatry

With his film, Andrés Muschietti has inserted himself among attachment theorists such as Klein, Bowlby, Thomas and Chess. The D'Asange children were 1- and 3-years-old when they were abandoned. Upon bring kidnapped by their father (and brought to Helvetia), the older Victoria drops her stuffed animal on the living room floor. The transitional object is a symbol of the girls’ vulnerability during the critical period of language development. Once discovered, Victoria assimilates to her new family much easier than Lilly, whose attachment to Mama is tested right up to the movie’s cliffhanging climax.

At Rutgers Robert Wood Johnson Medical School, the first module – titled Necromancy – of our year-long resident Psychopathology course focuses on ghosts (wraiths) and demons. While the latter reinforce teaching points of chronic and persistent illnesses, ghost stories are told to review disorders that are episodic in nature such as Major Depressive Disorder.

“A ghost is an emotion bent out of shape…until it rights a wrong.”

Despite Dr. Dreyfuss (a psychiatrist) diagnosing Victoria with Dissociative Identity Disorder (misstated as Dissociative Personality Disorder), Mama’s true affliction is later revealed by Victoria, “It was a long time ago. A lady ran away from a hospital for sad people. She took her baby. They jumped into the water.” As such, Mama is a case study about Major Depressive Disorder, with Peripartum Onset (postpartum depression).

Key Words: Virginia, Mama, Helvetia, attachment theory, Melanie Klein, John Bowlby, Alexander Thomas, Stella Chess, transitional object, Donald Winnicott, Dissociative Identity Disorder, Major Depressive Disorder with Peripartum Onset, postpartum depression

Next week’s movie: Pumpkinhead (1988)

Movie of the week: Pumpkinhead (1988)

Last week’s movie: Mama (2013)

Synopsis

Inspired by a poem by Ed Justin, Pumpkinhead is a cult classic horror film about Ed Harley’s inner demon manifest as one of the most Underrated Horror Killers of all time (Tyler Doupe, 2013).

The supernatural Scarecrow Folk is introduced in the movie’s opening scene, and returns about 30 years later when Harley swears revenge on a group of teenagers who mortally wound his son while operating a motorcycle under the influence of alcohol. Upon consulting a witch in a cabin in the woods, Harley goes to Razorback Hollow to exhume the eponymous legend, revenge incarnate.

How it relates to the field of psychiatry

Pumpkinhead shares the same archetypal warning (trope) with January 23’s film, A Nightmare on Elm Street; there’s a steep price to pay for exacting revenge. The film revisits the internal conflict between what “we would like to do” versus society’s prohibitions about what we should do, and applies this to a case of child murderers. With superego (frontal lobe) dysfunction, people like Harley lose the protective cortical effect and succumb to the impulsivity of the id which is driven by the pleasure principle.

When bent on revenge, one can lose oneself, as evidenced by Harley experiencing the deaths of the teenage campers through the eyes of Pumpkinhead, then ultimately taking on the image of Pumpkinhead, itself. In this way, the film is analogous to the infamous Stanford prison experiment that investigated how readily people would conform to the roles of guard and prisoner in a role-playing exercise that simulated prison life (Zimbardo, 1973). A depiction of the experiment that’s less metaphorical than this week’s movie is Paul T. Scheuring’s The Experiment (2010). Similar to Zimbardo’s findings, Harley isn’t hardwired to be sadistic, but instead is influenced by environmental stress (death of his son) to do what he does; an action for which he pays the ultimate price (loses himself).

Key Words: North Carolina, Pumpkinhead, Scarecrow Folk, cabin in the woods, Joss Whedon, revenge, dish best served cold, A Nightmare on Elm Street, Sigmund Freud, id, ego, superego, pleasure principle, Zimbardo, The Experiment

Next week’s movie: The New Daughter (2009)

Movie of the week: The New Daughter (2009)

Last week’s movie: Pumpkinhead (1988)

Synopsis

Based on a short story of the same name by John Connolly, The New Daughter tells the story of a novelist, John James, and his two children who encounter a malevolent presence when they move into their new house.

One day, while exploring the surrounding fields of their new home, the James children come across a large mound to which Louisa is strangely attracted. John soon learns that his new home is an urban legend; locally infamous for the disappearance of a woman who previously lived there.

How it relates to the field of psychiatry

The burial mound, Louisa’s strange attraction to it, and her consequent symptoms all support a case of ghost sickness; a culture bound syndrome that occurs among Native American tribes, originating from the Navajo. First, the sufferer is obsessed with death or a certain deceased person (many Native Americans with ghost sickness may have actually be suffering from a complicated bereavement). While we don’t know the ancestry of the James family, ritualized mound burials link cultures across the globe, explaining why Louisa would be at risk for developing ghost sickness. Furthermore, the woman who previously lived in the home (the object of Louisa’s obsession) may have been of Native American heritage. A common belief among the Kwakiuti tribe is that a child’s soul is weaker than that of an adult. Taken together, children such as Louisa would be more vulnerable to develop ghost sickness than adults. An alternative theory is that John killed his ex-wife and buried her under the mound on his new property, thus explaining Louisa’s pathological grief process.

In any case, the sufferer begins to have nightmares and dreams, then later feels queasy when the physiological and psychological symptoms set in. Louisa demonstrates additional symptoms of ghost sickness including a change in appetite, depression, and irritability. She has nightmares and sleepwalks the night after she lies on the mound. The next day, John is called by the school to pick up Louisa who is nauseous.

Key Words: South Carolina, New Daughter, John Connolly, cabin in the woods, burial ground, ghost sickness, culture bound, Navajo, Complicated Bereavement, Kwakiuti

Next week’s movie: Deliverance (1972)

Movie of the week: Deliverance (1972)

Last week’s movie: The New Daughter (2009)

Synopsis

Based on a novel of the same name by James Dickey, Deliverance is a 1972 thriller selected for preservation in the US National Film Registry by the Library of Congress as being “culturally, historically, or aesthetically significant.” The landmark film depicts four Atlanta businessmen and their excursion into the Cahulawassee River Valley where they become the objects of the nature versus civilization motif of the ages. Of note, this blog was originally posted on MedEdPORTAL on Friday, April 3, 2015 (Good Friday; the day Dante Alighieri embarks on his journey through the Inferno).

How it relates to the field of psychiatry

Widely acclaimed as a landmark picture, the film is noted for 2 memorable scenes, the first of which has one of the city men dueling on guitar with a country boy playing banjo. The early scene, which ends with Ed admitting defeat, “I’m lost,” sets the tone for what lies ahead; a trip into the unknown and potentially dangerous wilderness. Like many movies and literary works, Deliverance uses the journey to juxtapose the human element (city-dwellers) against nature (powerful forces of nature/supernatural). In this way, Deliverance parallels Dante Alighieri’s Divine Comedy (1320), specifically, the pilgrim becoming lost (like Ed) in the dark wood, and his journey into The Inferno.

The musical scene in Deliverance, then, is a warning to the urban pilgrims to “Abandon All Hope” (“All hope abandon, ye who enter here”). Perhaps the opening scene of the movie could read: Midway on our their life’s journey, I four Atlanta businessmen found myself themselves in dark woods, the their right road lost. The setting of the film, the Cahulawassee River, parallels the Styx, with all of its hidden dangers. The dammed up river is the impetus for the group to pursue the river’s wild, and therefore conjures the leopard, lion, and she-wolf of the Inferno (symbolizing the executives’ sins which are about to merge with, if not cause, the danger that awaits them).

While Deliverance can be interpreted through the perspective of the group, the film may also be seen through the eyes of one of its core characters, Ed Gentry. In a second landmark scene - the rape of Bobby (“squeal like a pig”) - the audience has the shared perspective of Ed. Keeping consistent with the movie’s theme as their own private Hell/Inferno, Ed appears to be the most even-keeled, the central character through whom everyone else is defined; i.e. Dante, the pilgrim (as such, the other characters each demonstrate traits upon which Dante Alighieri built his satire, see table 6). Unlike Dante, whose path to the mountaintop is blocked by the leopard, lion, and she-wolf, Ed successfully climbs the cliff near the end of the movie. At Rutgers Robert Wood Johnson Medical School, the Personality Disorders are taught as a journey through Dante’s Inferno, with each circle of hell corresponding to a specific disorder. Deliverance also allows for review of the Personality Disorders as seen through the eyes of Ed Gentry, a modern-day Dante. Table 2 lists Deliverance’s allusions to films that are referenced in our course syllabus.

Table 6. Symbolism in Deliverance & Parallels to Dante’s Inferno Deliverance Deadly Sin Dante’s Character Character Ed None Dante Lonnie Gluttony Ciacco Lewis Envy Father of Francesca da Polenta Bobby Sloth Filippo Argenti Drew Mountain Men Lust Francesco & Paolo Other Unnamed gas attendant Minos Griner brothers Virgil Appalachia Dark Wood Cahulawassee River Styx

Table 7. Tropes & Archetypes in Deliverance and References to Other Films Scene from Deliverance Reference Year Lewis complains, “Machines are Mary Shelley’s Frankenstein 1818 going to fail…survival” The Terminator 1984 The Matrix 1999 Lewis posits, “Sometimes you have Fight Club 1993 to lose yourself so you can gain everything” Saw 2003 The nature-loving campers clash The Beach 2000 with the native moonshiners (Mountain Men) Lewis convinces the group to A Nightmare on Elm Street 1984 conceal the dead body and take the law into their own hands In the final scene, Ed has a Carrie 1976 nightmare of the dead Mountain Man’s hand reaching up out of the water Friday the 13th 1980

Key Words: Georgia, Deliverance, Cahulawassee River, dueling banjos, squeal like a pig, Dante’s Inferno, personality disorders

Next week’s movie: Jeepers Creepers (2001) Movie of the week: Jeepers Creepers (2001)

Last week’s movie: Deliverance (1972)

Synopsis

Jeepers Creepers is a 2001 horror film written and directed by Victor Salva that takes its name from the 1938 song first premiered by Louis Armstrong. The film is inspired by actual events (Unsolved Mysteries). Since this blog was started on Easter Sunday 2015, it was exactly 25 years ago that Ray and Marie Thornton were terrorized by a motorist while playing “the license plate game” in Cold Water, Michigan. Also, like their counterparts in the movie, the Thorntons later came across the van and discovered a bloody sheet. While the Thornton’s experience remains unsolved, the 2001 horror movie it inspired depicts the fate of siblings Trish and Darry Jenner on their travels home from college during spring break in the Florida countryside.

On their way home, a mysterious driver attempts to run Trish and Darry off the road with his truck. After barely escaping a second time, Darry convinces Trish to double back to investigate what they saw earlier at the “psycho version of the Sistine Chapel.” The two find an old woman (an oracle) who tells them of “The Creeper,” a demonic keeper of a “house of pain” who hunts every twenty-third spring for twenty-three days by striking fear into its victims in order to smell if there’s something it likes. It then feasts on the terrified victims’ body parts to reconstitute and strengthen itself.

The eponymous “Creeper” is the reincarnation of Spring-heeled Jack, a supernatural entity of English folklore of the Victorian era (sightings were especially prevalent in London). The cyclical nature of his hunting sprees parallels that of other geographically isolated mythical characters such as the Mothman (West Virginia) and It (Maine).

How it relates to the field of psychiatry

Beyond the role urban legends play in the psychology of a culture, Jeepers Creepers is useful in reviewing the harmful effects of two drugs: alcohol and phencyclidine (PCP). In the opening scene, Darry recounts the cautionary tale of Kenny and Darla (class of ’78), a prosocial warning of the dangers of drinking and driving on prom night (Weird New Jersey’s Annie’s Grave in Totowa and The White Lady Tree in Branch Brook Park).

Later in the movie, Darry and Trish are trapped in the police station when the Creeper’s rampage is reminiscent of the scene from The Terminator. Similar to the cyborg portrayed by Arnold Schwarzenegger, the Creeper demonstrates the behavioral (belligerence and agitation) and physiologic (diminished pain response when it’s described as wearing body armor by police) manifestations of PCP intoxication. It’s only right that the final thought in this blog parallels the final scene in the film. Co-occurring use of alcohol and PCP may lead to suicidal behaviors and other symptoms including (ironically) rapid eye movements (nystagmus), eyes rolled to the back of the head, and a vacant stare.

Key Words: Florida, Jeepers Creepers, the Creeper, Louis Armstrong, Unsolved Mysteries, Ray Thornton, Marie Thornton, Mothman, Stephen King’s It, Spring-heeled Jack, alcohol, Phencyclidine, PCP, The Terminator

Next week’s movie: Laid to Rest (2009)

Movie of the week: Laid to Rest (2009)

Last week’s movie: Jeepers Creepers (2001)

Synopsis

Laid to Rest is a 2009 slasher film depicting the “amnestic protagonist.” It follows a young woman who awakens in a casket with amnesia, and her attempts to recover her lost memories, the most disturbing of which is that she’s a victim of a serial killer who taunts the police by videotaping his victims.

How it relates to the field of psychiatry

An unnamed woman awakens to find herself in a casket, without any knowledge of where she is or how she got there. In fact, she demonstrates retrograde amnesia, unable to recall any long- term memory (episodic or semantic). She complains of a headache, and appears confused as she tries to escape the mortuary and its video-taping, sadistic inhabitant, ChromeSkull.

Locked in the embalming room, she is nearly rescued by an elderly mortician with a “lazy eye” (cranial nerve palsy) before ChromeSkull impales him. We later learn upon discovery of one of the video tapes that Mr. Jones was an accomplice, Chrome Skull’s Renfield, who regained compassion for the girl before being killed in an attempt to rescue her.

Upon her escape, the woman flags down a lone passer-byer, Tucker, who refers to her as “Princess.” As the story unfolds, Princess’s psychiatric symptoms (amnesia) combine with Tucker’s physical deficit (impaired gait) to derail their multiple attempts to reach safety.

Finally, we discover that ChromeSkull is a psychotic serial killer who has been abducting young women beginning in south Florida. He posed as a ‘john’ to abduct Princess, a prostitute who is seen on a video tape snorting cocaine just before being assaulted with a baseball bat (and ending up in a casket). While the details of Princess’s history explain her recent experiences including the headache, an alternative interpretation (scar notwithstanding) allows for an interesting psychiatric synopsis.

It may be reasonable to assume that Princess likely abused alcohol in addition to cocaine. Taken together, Laid to Rest may be interpreted as a case study of Alcohol Withdrawal, which can be reviewed in 3 phases. The first phase, uncomplicated withdrawal, results from cessation of alcohol when use has been heavy and prolonged. Interestingly, the one criterion from the Clinical Institute Withdrawal Assessment (CIWA is the gold standard for symptom-triggered therapy) that is not included in the DSM-5 diagnostic criteria is headache.

The second phase, complicated withdrawal, is hallmarked by either seizures or hallucinations. The latter may be due to a) Alcoholic Hallucinosis or b) Alcohol Withdrawal Delirium (Delirium Tremens, DT’s). The third phase, Wernicke-Korsakov syndrome, may begin with a triad of confusion (Princess), ataxia (Tucker), and eye findings (Mr. Jones). If left untreated, Wernicke’s encephalopathy (confusion) may evolve into Korsakov psychosis (KP). KP is a likely irreversible neurologic syndrome characterized by amnesia (while Princess demonstrates retrograde amnesia, KP more commonly presents with anterograde amnesia/difficulty with encoding new memories), confabulation (the creation of false memories), and perceptual disturbances (psychosis). While ChromeSkull may represent “a psychotic serial killer,” he may only be a figment of Princess’s imagination; a product of her delusional belief system resulting from years of alcohol abuse and subsequent Wernicke-Korsakov syndrome. While the 3 forms of alcohol withdrawal are presented here as 3 distinct phases, they need not appear in any particular order. As confabulation is not depicted in the film, so too may alcohol withdrawal not include specific symptoms.

Key Words: Alabama, Laid to Rest, ChromeSkull, alcohol withdrawal, retrograde amnesia, anterograde amnesia, cranial nerve palsy, ataxia, Alcoholic Hallucinosis, Alcohol Withdrawal Delirium, Delirium Tremens, DT’s, confabulation, CIWA, Wernicke-Korsakov syndrome

Next week’s movie: The Beast Within (1982)

Movie of the week: The Beast Within (1982)

Last week’s movie: Laid to Rest (2009)

Synopsis

The Beast Within is a horror film loosely based on Edward Levy’s 1981 novel of the same name. The film opens in 1964 Nioba, Mississippi with newlyweds, Caroline and Eli MacCleary, stranded on a deserted road. Caroline is knocked unconscious and raped by an unknown entity. The film then picks up 17 years later in Jackson, Mississippi, and depicts the trials of the MacCleary family as it deals with unexplained symptoms of their 17-year-old son, Michael.

How it relates to the field of psychiatry neuropsychiatry

The Beast Within may be viewed as a case study to review the signs of Neurofibromatosis type 2 (NF2), a hereditary condition most commonly associated with bilateral vestibular schwannomas, also known as acoustic neuromas. These benign tumors grow on the nerves of the inner ear and commonly cause tinnitus which is experienced by Michael throughout the movie as a cicada-like ringing. In the film, Eli and Caroline decide to confront their past and return to the small town of Nioba, Mississippi to hopefully discover some information about the man (Michael’s biological father) who sexually assaulted Caroline. The timing and nature of their search underscores 2 important facts; a) signs of NF2 usually develop in the late teenage years and b) NF2 is a hereditary condition.

Interestingly, Michael may also demonstrate mucosal neuromas (fattened lips of the beast), which along with his pituitary gland “going out of control” (adenoma), is consistent with Multiple Endocrine Neoplasia (MEN) syndrome type 1.

Key Words: Mississippi, Neurofibromatosis type 2, NF2, schwannoma, acoustic neuroma, Multiple Endocrine Neoplasia, MEN

Next week’s movie: Skeleton Key (2005)

Movie of the week: Skeleton Key (2005)

Last week’s movie: The Beast Within (1982)

Synopsis

We must have had a mishap crossing the Ole Miss, the Ole Man (Vacation, 1983), because Skeleton Key was mistakenly substituted for Interview with the Vampire. Nonetheless, in the former, Caroline Ellis takes a job as a live-in nurse to care for Benjamin, an elderly man suffering from the effects of a stroke. Through Luke, an estate lawyer, Violet Devereaux hires Caroline despite appearing put off by her Hoboken-esque appearance. Despite getting off to a rocky start, Violet entrusts Caroline with Benjamin’s health, and gives her a skeleton key that unlocks every door in the plantation house but one; she’ll unlock this door with the key of her imagination (Twilight Zone, 1963).

How it relates to the field of psychiatry

Skeleton Key is a film that depicts hoodoo (root work); a culturally sanctioned belief practiced in the southeast US. Hoodoo is a practice traced back to the early turn of the century that encompasses “folk magic” from African, Native American, and European cultures. Users of hoodoo conjure spells (brick dust, etc.) to access supernatural forces to improve their lives. Skeleton Key captures the mechanism of culturally sanctioned behavior; specifically the power of faith. This resonates throughout the film: from Jill’s reassurance, “It can't hurt you if you don't believe” to the final plot spin when Caroline enters the conjure room in the attic. This is the only room in the house that cannot be opened with the skeleton key, and can only be unlocked with faith.

The film also serves to review Benjamin’s portrayed affliction; cerebrovascular disease, likely subcortical vascular dementia (SCVD). SCVD, also called Binswanger’s disease, involves extensive microscopic damage to the small blood vessels in the white matter of the CNS. Benjamin’s character is accurate in that symptoms tend to begin after the age of 60 in individuals with a history of stroke. The characteristic features of Binswanger’s demonstrated by Benjamin include lack of facial expression and speech difficulties. The latter is captured in the curative spell conjured by Caroline, “His words have gotten lost...lost and wandering in his mind...”

Key Words: Louisiana, skeleton key, hoodoo, root work, folk magic, culturally sanctioned belief, subcortical vascular dementia, Binswanger’s disease

Next week’s movie: Texas Chainsaw Massacre (1974, 2003)

Movie of the week: The Texas Chainsaw Massacre (1974, 2003)

Last week’s movie: Skeleton Key (2005)

Synopsis

The Texas Chain Saw Massacre is a film produced by Toby Hooper that follows a group of friends who fall victim to a family of cannibals while driving through the barren back roads of Texas. The film is credited with originating several elements common in the Pre-Michael Myers slasher genre such as the characterization of the killer as a hulking faceless figure. As such, The Texas Chain Saw Massacre was inducted into the Horror Hall of Fame in 1990.

How it relates to the field of psychiatry

Edward Theodore Gein was born on August 27, 1906, to Augusta and George Gein in La Crosse, Wisconsin. Despite being a cold and domineering woman, Augusta was all that Ed had following the deaths of his father and older brother, Henry. Unfortunately, on December 29th, 1945, Augusta died. Ed Gein’s life fell apart after he “lost his only friend and one true love” (Deviant [book] by Harold Schechter). Ed remained in the house after his mother’s death and developed a morose interest in taxidermy. On November 17, 1957, police in Plainfield, Wisconsin arrived at the Gein farmhouse. The more they looked through the farmhouse, the more human trophies they found, including a suit made entirely of human skin. The serial murders of Ed Gein inspired several movies including The Texas Chainsaw Massacre, making the film a graphic depiction of Antisocial Personality Disorder.

Gunnar Hansen was selected for the role of Leatherface who he regarded as being afflicted with Intellectual Developmental Disorder (IDD). To research and develop Leatherface's mannerisms, Hansen visited a special needs school and watched how the students moved and spoke. Another faceless (goalie-masked) killer, Jason Voorhees (posted on February, Friday the 13th), was also scripted as having IDD. Not unlike individuals with Eating & Feeding Disorders, these 2 characters have significant difficulty describing how they feel, and therefore must rely on non- verbal means to communicate their emotions and unconscious conflicts. The Texas Chainsaw Massacre poses an interesting play on words; while depicting a character that communicates non-verbally like an individual with an eating and feeding disorder, Leatherface is part of a family of cannibals.

Key Words: Texas Chainsaw Massacre, Leatherface, Ed Gein, Antisocial Personality Disorder, Intellectual Developmental Disorder, Eating & Feeding Disorder, Jason Voorhees, Friday the 13th

Psycho-nicity: ‘Synchronicity’ is a Jungian term depicting the acausal connection of two or more psycho-physic phenomena. For our purposes, it serves as the root for a neologism (newly coined word), psycho-nicity; suggestions that make a movie a transcendental experience. A triple feature of The Texas Chainsaw Massacre, Psycho, and The Silence of the Lambs may be the most chilling movie series created given that Ed Gein inspired the creation of all 3 films.

Next week’s movie: A Perfect Getaway (2009)

Movie of the week: A Perfect Getaway (2009)

Last week’s movie: Texas Chainsaw Massacre (1974, 2003)

Synopsis

A Perfect Getaway is an action thriller (not quite horror) depicting Cliff and Cydney on their honeymoon hiking to a remote beach in Hawaii. Along the way, their relationship with the couples they meet is changed when they learn of a double murder in Honolulu where the victims had their teeth pulled out and fingertips removed. Cliff and Cydney must battle all of the hidden dangers nature and fellow hikers have to offer to survive their honeymoon in paradise.

How it relates to the field of psychiatry

There are 2 main themes illustrated in the film; one that’s a straightforward depiction, and one metaphorical. First, Cliff’s character depicts Antisocial Personality Disorder (APD). Unlike textbook descriptions, Cliff is charismatic, and wins over the audience (and Cydney) early in the movie. There’s no better explanation of this trait than in the book, The Sociopath Next Door. In her work, Martha Stout reveals that 4-5% of “ordinary people” have an undetected APD, the chief symptoms of which are the absence of empathy and compassion. Their allure is likely due to mechanisms similar to the Stockholm syndrome. Also depicted in the 2005 film, V for Vendetta, the term was coined by criminologist, Nils Bejerot, a consulting psychiatrist to a 1973 bank robbery in Stockholm, Sweden where several bank employees who were held hostage became emotionally attached to their captors.

On a more metaphorical level, A Perfect Getaway parallels hospital-acquired (nosocomial) infections. These bloodstream infections, pneumonias, urinary tract infections, and surgical site infections cost the US health care system almost $10 billion a year. The nosocomial infection rate has remained remarkably stable at approximately five hospital-acquired infections per 100 admissions (ironically the same percentage of people Stout identifies as afflicted with sociopathy).

Modern infection control is grounded in the work of Ignaz Semmelweis, who in the 1840s demonstrated the importance of hand hygiene for controlling transmission of infection in hospitals. Like nosocomial infections, Cliff and Cydney – the human element - pose a greater threat than anything in nature. Poetically, Cydney captures both layers of the film in the movie’s penultimate scene when she says that Cliff ruined her life, identifying him to the sniper, and “washing her hands” of her sociopathic, albeit charismatic, husband.

Key Words: Hawaii, Antisocial Personality Disorder, The Sociopath Next Door, Martha Stout, Stockholm syndrome, Nils Bejerotm, V for Vendetta, nosocomial infection, Ignaz Semmelweis

Next week’s movie: 30 Days of Night (2007) Movie of the week: 30 Days of Night (2007)

Last week’s movie: A Perfect Getaway (2009)

Synopsis

The polar night is the setting for 30 Days of Night, a horror film based on the comic book miniseries of the same name. Barrow, Alaska is preparing for its annual month-long polar night when a stranger rows ashore from a large ship. When detained, the stranger (the Harbinger archetype) taunts the townsfolk, telling them that death is coming. The mysterious visitor is the reincarnation of Renfield, the chosen one who prepares for the coming of the vampire scourge.

How it relates to the field of psychiatry

The vampire genre found its popularity with publication of Bram Stoker’s Dracula in 1897. Texts such as An Extraordinary and Shocking History of a Great Berserker Called Prince Dracula served as inspiration for Stoker’s monster. Stoker’s working papers for Dracula were discovered in the Rosenbach Museum in Philadelphia, confirming that he knew about the existence of Vlad Dracula, otherwise known as Vlad the Impaler. While the vampires in 30 Days of Night have features reminiscent of Nosferatu, the film pays homage to Stoker’s seminal novel. For example, when investigating the power outage, Eben goes to the telecommunications center and finds the operator’s head on a spike. Stoker’s eponymous character being killed with a spike through the heart was inspired by Vlad Dracula’s impaling thousands of the Sultan’s men on wooden stakes. With the creation of the vampire inspired by “Prince Dracula,” the apex predator then serves as a metaphor for Antisocial Personality Disorder (APD) given that the Count demonstrates reckless disregard for and violation of Jonathon Harker’s and other’s rights.

The town of Barrow succumbs to “30 days of night,” making the movie an allegory of Major Depressive Disorder with seasonal pattern (Seasonal Affective Disorder). This condition manifests with depressive symptoms at characteristic times of the year (episodes usually begin in fall or winter and remit in spring). Since the characters’ behavior is significantly influenced by the vampiric plague, with vampires serving as metaphors for APD, then 30 Days of Night may be interpreted as a case of “Secondary Depression;” a condition characterized by depressive symptoms thought to be caused by an underlying (e.g. antisocial) personality disorder.

Key Words: 30 Days of Night, polar night, Renfield, vampire, Dracula, Antisocial Personality Disorder, Major Depressive Disorder, Seasonal Affective Disorder, Secondary Depression

Next week’s movie: Cube (1997)

Movie of the week: Cube (1997)

Last week’s movie: 30 Days of Night (2007)

Synopsis

Cube is a SciFi horror film about a group of “subjects” who awaken in a room with anterograde amnesia as to how (or why) they got there. The characters discover that their new prison cell is one of 17,576 rooms that form a government-sanctioned cube with booby-traps that impede their search for an exit. The strangers must overcome significant trust issues and work together to solve the puzzle of the cube to gain their salvation.

How it relates to the field of psychiatry

The original group of 4 characters finds Kazan, an occupant of the cube who is stricken with an adult autistic disorder, likely Asperger’s syndrome. Two psychiatric comorbidities affecting people with Asperger’s syndrome include Social Anxiety Disorder (SAD) and Posttraumatic Stress Disorder (PTSD). Cube serves to review these 2 disorders through analysis of its 2 main characters. The group travels silently through a room with a sound-activated trap. After Kazan makes a sound and nearly causes Quentin's death, Quentin threatens Kazan. This interaction moves the narrative forward, as these 2 characters symbolize the yin-yang of the group’s efforts to escape.

Affecting 1 in 68 children (CDC, 2014), individuals with an autism spectrum disorder have high levels of psychiatric comorbidity including SAD. The film serves as a metaphorical platform to discuss the treatments for SAD including group therapy, flooding (in vivo exposure therapy), and novel psychopharmacological therapies such as 3,4-methylenedioxy-methamphetamine (MDMA). MDMA (ecstasy) produces effects characteristic of psychedelics (hallucinogens) and amphetamines. Renewed research interest in MDMA and anxiety builds on earlier studies of lysergic acid diethylamide (LSD) and psilocybin in treating autistic minors (who were misdiagnosed as having childhood schizophrenia). The drug’s hallucinogenic effect may also explain Kazan’s subjective reality of being imprisoned in the cubic colossus.

Another comorbidity of Asperger’s syndrome is PTSD. This illness is likely depicted by Quentin, a police officer. NMDA inhibits the activity of the left amygdala (lessens the fear response) while increasing the activity in the prefrontal cortex (Mithoefer, 2011) thus dampening the conditioned fear response. [Spoiler Alert] Kazan and Quentin are the last men standing, with the former leaving through the hatch into the bright light, a metaphor for a breakthrough in psychotherapy.

Key Words: Cube, Asperger’s syndrome, autism spectrum disorder, Social Anxiety Disorder, flooding, exposure therapy, 3,4-methylenedioxy-methamphetamine, MDMA, ecstasy, psychedelic, classic hallucinogen, lysergic acid diethylamide, LSD, psilocybin, shrooms, Posttraumatic Stress Disorder, PTSD, amygdala, prefrontal cortex

Next week’s movie: The Ring (2002)

Movie of the week: The Ring (2002)

Last week’s movie: Cube (1997)

Synopsis

The Ring is a remake of Ringu, a 1998 Japanese horror film that draws on the folk tale, Banchō Sarayashiki. As legend tells it, there was once a beautiful servant named Okiku who worked for a samurai, Aoyama Tessan. Okiku often refused his amorous advances. Despite his trickery, Okiku remained solemn. Aoyama became enraged, and threw her down a well to her death. It is said that Okiku became a vengeful spirit (Onryō) who tormented her murderer.

In the 2002 American adaptation, a group of teens watch “a video tape that kills you when you watch it.” After watching the tape, the phone rings, and the voice on the other end utters “seven days.” Exactly one week later, you die. The film depicts Rachel Keller, an investigative reporter, who is looking into her niece’s death when she discovers the urban legend.

The Ring may have also been inspired by The Tragedy at Road Hill House. In June 1860, 3-year- old Francis “Saville” Kent disappeared from his home. His body was found in a privy on the property. While the boy’s nursemaid, Elizabeth, was initially arrested, Francis’s sister, Constance Kent, would confess to the murder five years later.

Yet another perspective comes from the study of the corporeal undead. Also known as “utburd,” mylings are phantasmal incarnations of the souls of unbaptized children who are forced to roam the earth until they could persuade someone to bury them properly. Mylings – translated as “that which is taken outside” - refer to the practice of abandoning unwanted children (usually in the woods where death is almost certain). In The Ring, the teens discover Samara’s myth in a cabin in the woods. Interestingly, another Asian (Tai) horror film depicting a “floaty girl” continues this narrative. Shutter (2004) illustrates how mylings chase lone wanderers at night and jump on their backs, demanding to be carried to the graveyard so they can rest in hallowed ground. In The Ring, Rachel discovers Samara’s body, and she’s given a proper burial in 7 days.

How it relates to the field of psychiatry

Two taglines from the movie highlight teaching points in psychiatry. First, “she never sleeps” hallmarks the inevitability of death. Interestingly, a story with the same moral, Appointment in Samarra, shares its title name (synonym) with The Ring’s evil antagonist. Second, “she only wants to be heard” represents a major theme in patient-centered medicine, with patient histories - and the need for patients to convey them in a milieu of unconditional positive regard (Carl Rogers) - being a critical component of healthcare. Another teaching point focuses on whether Samara is “pure evil.” The Ring is a fictional case study of a “bad seed” (see Damien from The Omen, 1976) in the ‘nature versus nurture’ discussion of the etiology of Antisocial Personality Disorder.

Finally, a third psychiatric teaching point focuses on the nonverbal communication of horses. In the film, the horses at the Morgan ranch went mad and drowned themselves, a fate similar to the horse on the ferry on the way to Richard Morgan’s island home. The animal’s intuition is scientifically based. As prey animals, horses have hearts 5x the size of humans'. Their electromagnetic pulse (torus) results in a coherent heart rate that synchronizes with humans (or mylings). Institutions of higher education such as Rutgers Robert Wood Johnson Medical School take advantage of the coherent heart rate of horses by partnering with equine centers (Spring Reins of Hope) to run innovative curricula that use horses to teach medical students nonverbal communication to improve bedside manners.

Key Words: The Ring, Banchō Sarayashiki, The Tragedy at Road Hill House, cabin in the woods, Francis “Saville” Kent, utburd, myling, Shutter, unconditional positive regard, Carl Rogers, The Omen, nature versus nurture, Antisocial Personality Disorder, Appointment in Samarra, coherent heart rate, torus, equine assisted therapy, Spring Reins of Hope

Psycho-nicity: Watch The Ring back-to-back with Shutter to experience the full wrath of the myling (add Cabin in the Woods to make it a trilogy of horror).

Next week’s movie: The Fog (1980; 2013)

Movie of the week: The Fog (1980; 2013)

Last week’s movie: The Ring (2002)

Synopsis

The Fog is a film directed by John Carpenter told as a campfire tale about a town haunted by corpses from a 100-year-old shipwreck. The fishermen’s legend foretells that at midnight on April 21, when the fog rolls in, the corpses will arise from the sea in search of the campfire that originally “lead them to their dark, icy death.”

The movie is set in Spivey Point, 1980, where local fishermen spot a ghost ship carrying corporeal undead. While the US culture has focused on vampires, skeletons, mummies, and zombies, The Fog likely depicts undead fiends from Norse mythology; draugrs. Literally “after- walker,” draugrs are undead creatures that guard treasures after death (derivation of the term Dragon). Draugrs rise from the grave as wisps of fog, and possess superhuman strength, the power to control the weather, and the ability to curse a victim.

The power to curse a victim is the major theme of another nautical tale: The Rime of the Ancient Mariner, a Samuel Taylor Coleridge poem inspired by the Flying Dutchman, a ghost ship captained by Vanderdecken. In The Rime of the Ancient Mariner, a ship encounters the ghostly Flying Dutchman. On board are Death (actually, the undead; a skeleton) and the “Life-in-Death” (a deathly-pale woman) playing dice for the souls of the crew. Life-in-Death wins the life of the Mariner; he will endure a fate worse than death as punishment for his offense (killing the albatross). As penance for shooting the albatross, the Mariner is forced to wander the earth and tell his story, teaching a lesson to those he meets.

In Coleridge’s poem, the Mariner is cursed by Life-in-Death for killing an albatross. In Carpenter’s adaptation, the town of Antonio Bay is cursed for its own “albatross”; in 1880, six of the town founders deliberately sank a clipper ship named the Elizabeth Dane. The ship was owned by a wealthy man named Blake, who wanted to establish a leper colony near Antonio Bay. One foggy night, the 6 conspirators lit a fire on the beach near treacherous rocks. Deceived by the false beacon, the ship crashed into the rocks and perished.

On the centennial anniversary of Antonio Bay, a local radio DJ is given a piece of driftwood inscribed with the word “DANE.” In addition to being the name of the ill-fated ship, the inscription also establishes Norse mythology as the origin of the curse. To establish the town charter, the 6 townspeople plundered the wrecked ship. As guardians of treasures after death, draugrs will exact revenge on the descendants who murdered, plundered, and founded the town of Antonio Bay. How it relates to the field of psychiatry

Since The Fog is told as a campfire tale, the storyteller’s character parallels that of the Mariner who was forced to wander the earth and tell his story. The storyteller’s cautionary tale is that we are the product of our early experiences. While set in the fictional town of Spivey Point, the story’s real setting is the vast ocean and all of its mystery. Just as all the danger lies below the ocean’s surface, so too do our early experiences shape our unconscious (subcortical hippocampus and amygdala).

Key Words: The Fog, Antonio Bay, corporeal undead, Norse mythology, draugrs, dragons, The Rime of the Ancient Mariner, Samuel Taylor Coleridge, Flying Dutchman, Life-in-Death, Elizabeth Dane, hippocampus, amygdala

Next week’s movie: Tremors (1990)

Movie of the week: Tremors (2006)

Last week’s movie: The Fog (1980; 2013)

Synopsis

Tremors is a 1990 horror film depicting Val and Earl, two handymen, who, along with Rhonda LaBeck, discover the shocking cause of seismic activity in the desert of Perfection, Nevada.

How it relates to the field of psychiatry

Val and Earl are on horseback looking for help when they discover Wallace’s buried car. With Wallace and his wife missing, they press on when an eruption reveals an enormous burrowing worm-creature. The creature, a graboid, is a metaphor of anxiety. Similar to anxiety resulting from intra-psychic conflict arising from below the level of consciousness, graboids cause significant distress from below the desert’s surface. Given the town’s name of Perfection, Tremors can be conceptualized as a case study of Obsessive Compulsive Personality Disorder (OCPD).

OCPD is a personality disorder hallmarked by a pervasive pattern of preoccupation with perfection (as the Nevada town is aptly named) and control that causes clinically significant distress or impairment in social or occupational functioning. The psychodynamic etiology of OCPD focuses on maladaptive defense mechanisms: unconscious ego processes that alleviate anxiety caused by the mismatch between the id (what we want to do) and the superego (what we’re allowed to do).

Three ego defense mechanisms define OCPD. First, isolation of affect (isolation) is objectifying and emotionally detaching oneself from a thought so as to avoid the painful feeling associated with a thought. The second defense mechanism, undoing, is the unconscious attempt to reverse a thought or feeling by performing an action that signifies an opposite feeling (e.g. compulsive hand washing to counter thoughts of infestation). Third, reaction formation includes adopting beliefs, attitudes, and feelings contrary to what you really feel (e.g. the individual expresses inner turmoil as perfect orderliness by having his tie pulled tight and beard always trimmed).

Interestingly, Graboids have as many life-cycle stages as OCPD has characteristic defense mechanisms:

 The first is the underground dwelling stage (isolation)  The second is the walking stage when the graboid leaves its underground skin and grows two legs (undoing)  The third is the flight stage where they sprout wings (reaction formation) Key Words: Tremors, graboid, Obsessive Compulsive Personality Disorder, OCPD, defense mechanisms, id, ego, superego, isolation of affect, undoing, reaction formation

Next week’s movie: Scream (1996)

Movie of the week: Scream (1996)

Last week’s movie: Tremors (2006)

Synopsis

On March 18, 1940, in a small Missouri town, Janette Christman babysat for the Womack family. That night, she was raped and strangled with an ironing cord. Along with the death of Marylou Jenkins (who was also raped and strangled with an electrical cord 4 years prior) and the biography of Daniel Harold Rolling (Gainesville Ripper), her murder inspired a genre of film that included When a Stranger Calls (1979). 17 years later, Wes Craven would direct Scream, a slasher film that depicts Sidney Prescott, a high school student in the fictional town of Woodsboro, who is stalked by a mysterious killer known as Ghostface.

How it relates to the field of psychiatry

Scream is a horror movie about horror movies. As the plot develops, the characters continually reference the multitude of horror films that inspired their own creation. In this way, Scream is a forerunner to Cabin in the Woods, explaining why audiences are drawn to the genre. Films like Scream resonate with us because the tropes are archetypes of our collective unconscious. In Craven’s film, we learn of the Jungian archetypal warning of what happens when you neglect your responsibility when caring for children. Similar to Halloween (1978) and Friday the 13th (both are, of course, referenced in Scream), Casey is talking to her boyfriend when she’s supposed to be watching the children. Ghostface then represents the keeper of prosocial norms that ensure the preservation of cultural values such as the welfare of children. This is the minor (familial) Father archetype that represents the virtues of sternness and control.

An unplugged version of Blue Öyster Cult’s (BOC) Don't Fear the Reaper plays softly in the background while Sidney and Billy discuss the intimacy of their relationship. The music is highly symbolic. Among its many themes is its literal message to join the reaper/Ghostface [spoiler alert] who turns out to be Billy. Since Billy is the reaper, Billy is dead (he experienced an emotional death when his mother left him). In joining Billy’s alter ego (reaper), Sidney then would be committing suicide. Billy’s (and BOC’s) message is clarified; this film is a depiction of a murder-suicide. In this way, Scream is an 80’s version of Shakespeare’s Romeo & Juliette.

The film also depicts Persistent Complex Bereavement Disorder in its main character. Specifically, Sidney demonstrates intense emotional pain in response to the death of her mother, and remains preoccupied with the circumstances surrounding her death. Given that Sidney is “contemplating suicide” and appears underweight, an eating disorder should also be in the differential diagnosis. In previous submissions (see Carrie, 7/4/14), we’ve discussed how movies that depict matricide (especially by an adolescent female) are analytic depictions of Anorexia Nervosa. Taken together, the audience is made to consider whether Sidney had an active role in her mother’s murder. This consideration sheds a different light on the dynamics between the characters. For example, is Billy’s message to “join the reaper” instead an invitation for Sidney to rejoin Randy and him in another murder spree? This interpretation also transforms the hated character of Gail Weathers, a shallow reporter who is in search of the truth behind the original murder, into one whose harassment of Sidney is deemed justifiable if Sidney actually did play an active role in her mother’s death. It isn’t surprising, then, that Gail just so happens to end the movie with an impromptu news report about the night’s events.

Key Words: Scream, Munch, Janette Christman, Marylou Jenkins, Daniel Harold Rolling, Gainesville Ripper, When a Stranger Calls, Wes Craven, slasher, Ghostface, Halloween, Friday the 13th , Jung, Blue Öyster Cult, Don't Fear the Reaper, Shakespeare, Romeo & Juliette, Persistent Complex Bereavement Disorder, Anorexia Nervosa, Carrie

Anthony Tobia, MD, Copyright © 2015 Rutgers Robert Wood Johnson Medical School. All rights reserved.